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Recommendations for the radiological diagnosis and follow-up of neuropathological abnormalities associated with tuberous sclerosis complex

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Abstract

Tuberous sclerosis complex (TSC) is a genetic condition with multisystem involvement, characterized by the development of tumors and other abnormalities in organs such as the brain, retina, skin, heart, kidneys, and lungs. Most patients have neuropathological abnormalities such as cortical tubers, white matter radial migration lines, subependymal nodules, and subependymal giant cell astrocytomas (SEGAs). These lesions are associated with different neurological manifestations that are frequently associated with TSC. These manifestations consist of epilepsy, intellectual disability, and neurobehavioral and psychiatric problems, including autism spectrum disorder. Hydrocephalus may also develop in patients with SEGAs due to ventricular obstruction, when this usually slow-growing tumor reaches sufficient size. Surgery has been the classical approach to treat SEGAs, although this treatment is associated with substantial morbidity and does not completely prevent tumor recurrence. Recently, the mammalian target of rapamycin (mTOR) inhibitor, everolimus, has been approved by the Food and Drug Administration and the European Medicines Agency for the treatment of patients with SEGAs associated with TSC. However, the treatment of SEGAs with these agents requires the development of guidelines that establish a differential diagnosis between SENs and SEGAs, in which neuroradiological examinations play an essential role. With the aim of improving the neuroradiological diagnosis and follow-up of the neuropathological abnormalities associated with TSC, a group of experts in this field has reviewed different aspects related to these issues and put together, a series of statements and recommendations intended to provide guidance to specialists involved in the management of TSC.

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Acknowledgments

The authors wish to thank Ana Martín from HealthCo S. L. (Madrid, Spain) for editing assistance in the preparation of the first draft of this manuscript. The scientific meetings along with medical writing services were supported financially by Novartis S. A. of Spain. Novartis S. A. of Spain was given the opportunity to comment on the first draft of the manuscript, but all the decisions about its content were taken by the authors

Conflict of interest

The authors declare that they do not have any conflict of interest that may inappropriately influence this work.

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Authors and Affiliations

  1. Neuroradiology Unit (IDI), Hospital Universitari Vall d’Hebron, Passeig de la Vall d’Hebron, 119-129, 08035, Barcelona, Spain

    Àlex Rovira

  2. Neuropediatrics Department, Hospital Infantil Universitario Niño Jesús, Avenida de Menéndez Pelayo, 65, 28009, Madrid, Spain

    María Luz Ruiz-Falcó

  3. Neuroradiology Department, Hospital Infantil Universitario Niño Jesús, Avenida de Menéndez Pelayo, 65, 28009, Madrid, Spain

    Elena García-Esparza

  4. Neuropediatrics Department, Hospital Universitario Reina Sofía, Avenida Menéndez Pidal, s/n, 14004, Córdoba, Spain

    Eduardo López-Laso

  5. Neuropediatrics Department, Hospital Universitari Vall D’Hebron, Passeig de la Vall d’Hebron, 119-129, 08035, Barcelona, Spain

    Alfons Macaya

  6. Child Neurology Unit, Pediatrics Department, Hospital Universitario Central de Asturias, Calle de Celestino Villamil, s/n, 33006, Oviedo, Spain

    Ignacio Málaga

  7. Pediatric Radiology Department, Hospital Universitari Vall d’Hebron, Passeig de la Vall d’Hebron, 119-129, 08035, Barcelona, Spain

    Élida Vázquez

  8. Neuroradiology Department, Hospital Universitario Reina Sofía, Avenida Menéndez Pidal, s/n, 14004, Córdoba, Spain

    Josefina Vicente

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  1. Àlex Rovira
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  2. María Luz Ruiz-Falcó
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  3. Elena García-Esparza
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  6. Ignacio Málaga
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  7. Élida Vázquez
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  8. Josefina Vicente
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Correspondence to María Luz Ruiz-Falcó.

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Rovira, À., Ruiz-Falcó, M.L., García-Esparza, E. et al. Recommendations for the radiological diagnosis and follow-up of neuropathological abnormalities associated with tuberous sclerosis complex. J Neurooncol 118, 205–223 (2014). https://doi.org/10.1007/s11060-014-1429-y

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  • DOI: https://doi.org/10.1007/s11060-014-1429-y

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