Preparation for Surgery for Subependymal Giant Cell Astrocytomas in Children

Indications for Surgery

• Hydrocephalus: The presence of elevated ICP due to obstructive hydrocephalus is a definite indication for urgent or emergent surgery.
• Growing tumor: More elective planned surgery should be done if there is a documented increase in the volume of the lesion.

Preoperative Orders

• IV: Good intravenous access and monitoring of vital parameters is essential, given that bleeding from the tumor surface can sometimes be problematic.
• Other: The preoperative work-up will include anticonvulsant levels and bleeding profile.

Anesthetic Considerations

• Anesthetic agents: No special consideration for anesthesia agents need be taken.

Devices to Be Implanted

• Ventricular drains: The authors do not routinely use ventriculoperitoneal shunts or EVD on these patients except when life-threatening hydrocephalus is present.

Ancillary/Specialized Equipment Required

• Operative microscope: The use of an operative microscope will improve the illumination and visibility of the operative field given the long, narrow corridor used to access the tumor.
• Intraoperative guidance: Computer-assisted neuronavigational devices and the intraoperative ultrasound can be useful for surgeries on SEGAs.
• Endoscope: Endoscopic equipment may be useful for an endoscopically assisted resection or for a more sophisticated imaged-guided interactive neuroendoscopy (6).
• Ultrasonic aspirator: This instrument may help in decompression of the tumor as its narrow profile and its combined ability to liquefy the tumor, irrigate, and aspirate allow visualization of the tumor during removal.
• Shielded bipolar cautery forceps: These are useful to avoid inadvertent superficial grounding and discharge of the bipolar’s current to the corticotomy tract and resection cavity.