• Tao Jiang, Jiang Du, RaynaldDepartment of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China; Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China., Junmei Wang, and Chunde Li.
• Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China; Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China.
• World Neurosurg. 2017 Nov 1; 107: 1053.e1-1053.e6.

BackgroundDirect surgical resection remains the standard treatment for patients with tuberous sclerosis complex (TSC) with a large subependymal giant cell astrocytoma (SEGA). Rapamycin or everolimus is seldom used in these patients because of the risk of increased intracranial pressure and possibility of sudden death.Case DescriptionsThree patients with TSC and a large intracranial SEGA received oral rapamycin (0.5 mg/day) or everolimus (2.5 mg/day) before surgery for tumor resection. After mTOR inhibitor therapy, computed tomography scans and magnetic resonance imaging revealed tumor reduction. Tumor bleeding was easy to control during surgery, and the border between tumor and surrounding brain tissue was clearly differentiated. Analysis of postsurgical tumor specimens showed low blood density and focal necrosis.ConclusionsPreoperative mTOR inhibitors could be a potentially novel treatment modality in large TSC-SEGA with hydrocephalus. In this series, mTOR inhibitors were not only safe and well tolerated, but also beneficial for tumor resection.Copyright © 2017. Published by Elsevier Inc.

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