OBJECT: Subependymal giant cell astrocytomas (SEGAs) are benign tumors, most 
commonly associated with tuberous sclerosis complex (TSC). The vast majority of 
these tumors arise from the lateral ependymal surface adjacent to the foramen of 
Monro, therefore potentially encroaching on one or both foramina, and resulting 
in obstructive hydrocephalus that necessitates surgical decompression. The 
indications for surgery, intraoperative considerations, and evolution of the 
authors' management paradigm are presented.
METHODS: Patients with TSC who underwent craniotomy for SEGA resection at New 
York University Langone Medical Center between January 1997 and March 2011 were 
identified. Preoperative imaging, clinical characteristics, management 
decisions, operative procedures, and outcomes were reviewed.
RESULTS: Eighteen patients with TSC underwent 22 primary tumor resections for 
SEGAs. The indication for surgery was meaningful radiographic tumor progression 
in 16 of 21 cases. The average age at the time of operation was 10.3 years. 
Average follow-up duration was 52 months (range 12-124 months). The operative 
approach was intrahemispheric-transcallosal in 16 cases, 
transcortical-transventricular in 5, and neuroendoscopic in 1. Nine tumors were 
on the right, 9 on the left, and 3 were bilateral. Gross-total resection was 
documented in 16 of 22 cases in our series, with radical subtotal resection 
achieved in 4 cases, and subtotal resection (STR) in 2 cases. Two patients had 
undergone ventriculoperitoneal shunt placement preoperatively and 7 patients 
required shunt placement after surgery for moderate to severe ventriculomegaly. 
Two patients experienced tumor progression requiring reoperation; both of these 
patients had initially undergone STR.
CONCLUSIONS: The authors present their management strategy for TSC patients with 
SEGAs. Select patients underwent microsurgical resection of SEGAs with 
acceptable morbidity. Gross-total resection or radical STR was achieved in 90.9% 
of our series (20 of 22 primary tumor resections), with no recurrences in this 
group. Approximately half of our patient series required CSF diversionary 
procedures. There were no instances of permanent neurological morbidity 
associated with surgery.