Subependymal giant cell astrocytoma natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ifeoma Odukwe, M.D. [2], Sujit Routray, M.D. [3]

Subependymal giant cell astrocytoma is generally located in the caudothalamic groove adjacent to the foramen of Monro and it presents commonly in the first two decades of life. It can lead to a few complications such as obstructive hydrocephalus, intratumoral hemorrhage, and death. Although the prognosis may be poor, patients who undergo surgical resection and those below the age of 18 have a better prognosis.

• Subependymal giant cell astrocytoma’s generally found in the caudothalamic groove adjacent to the foramen of Monro.^[1]
• It commonly presents in the first two decades of life.^[2]
• It is usually benign and slow growing but can progress to occluding the foramen of monro leading to obstructive hydrocephalus with symptoms of increased intracranial pressure.^[3]
• New tumors hardly arise after 20-25 years of age.^[1]

Common complications of subependymal giant cell astrocytoma include:^[4][5]

• Obstructive hydrocephalus
• Brain herniation
• Intratumoral hemorrhage
• Chronic ventriculoperitoneal shunt placement
• Stroke
• Sudden death

• Prognosis of subependymal giant cell astrocytoma is generally poor.^[6]
• It could be lethal, it is shown to be responsible for 25% of the excess mortality caused by the tuberous sclerosis complex.^[7]
• Surgical resection and age under 18 years are significant positive prognostic factors.^[8]
• Poor prognostic factors for subependymal giant cell astrocytoma include:^[1]

• Invasion to neighboring structures (fornix, hypothalamus, basal ganglia, or genu of internal capsule)
• Large sized tumors
• Recurrent tumors

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