ABSTRACT
OBJECTIVES: The indications for surgery and outcomes of patients who underwent surgical removal of subependymal giant cell astrocytomas (SEGAs) in our institution between 2000 and 2011 were reviewed. METHODS: We reviewed the clinical details of 16 patients with a diagnosis of Tuberous Sclerosis Complex (TSC) who underwent surgery for SEGA in Bristol since 2000. We collected information on age, sex, epilepsy history and cognitive status. We reviewed the indications for surgery, age at surgery, surgical approach, and the size and location of the lesions. We analysed mortality, completeness of tumour resection, intraoperative blood transfusion, shunt placements, and surgical complications. RESULTS: 13 patients had surgery due to hydrocephalus. Increasing size of SEGA without hydrocephalus was an indication for surgery in two patients, and in one patient, the SEGA was removed because of its size and location at initial scan. 13 patients had complete tumour resection. One patient had tumour recurrence. Hydrocephalus failed to resolve or reoccurred in four patients post operatively necessitating shunt insertion. The surgical approach was transcortical in 14 patients and transcallosal in two. There was zero mortality in this series. There were no reports of cognitive decline or worsening epilepsy following surgery. CONCLUSION: Surgery is a safe and effective treatment for SEGA. It is the authors' view that surgery remains the most appropriate treatment strategy for SEGAs that are amenable to surgery. More work needs to be undertaken to assess prospectively the neurocognitive impact of surgery, and the relative advantages of different surgical approaches.
Subject(s)
Astrocytoma/surgery , Brain Neoplasms/surgery , Tuberous Sclerosis/complications , Adolescent , Adult , Astrocytoma/etiology , Brain Neoplasms/etiology , Child , Child, Preschool , Female , Humans , Infant , Male , Neurosurgical Procedures , Retrospective Studies , Young AdultABSTRACT
Nurses in the emergency department will regularly encounter individuals with a learning disability in their day to day work. Admission to hospital and especially the emergency department can be very problematic for people with a learning disability. For a number of reasons the health, safety and welfare of this group of patients may be seriously compromised. An awareness of the risks associated with hospital care for these patients, along with an understanding of their specific needs, will help to minimise the potential for problems to occur.
