Fig. 2

Bilateral intraventricular sub-ependymal giant cell astrocytoma in an 8-year-old boy, who had generalized tonic-clonic convulsions. The patient had undergone an endoscopic biopsy and ventriculoperitoneal shunting, after which the seizures were controllable with medical treatment, and a decision of conservative management and serial follow-up imaging was taken. On 6-month follow-up, the seizures recurred and were difficult to control, and both tumors proved to have enlarged in size especially the right sided tumor. The right-sided tumor was surgically excised first through a right frontal trans-cortical approach, then the left-sided tumor was surgically excised in another session through a left frontal transcortical approach. a–c The initial axial, coronal, and sagittal contrast-enhanced brain MRI study. d–f Post-operative MRI following the first surgical session after excision of the right sided tumor which had enlarged during a 6-month follow-up period. g–i The final postoperative axial, coronal, and sagittal contrast-enhanced brain MRI study, which demonstrates total excision of both tumors. No CSF diversion was needed in this patient