Twenty-six patients with tuberous sclerosis have been reviewed from the standpoints of CT diagnosis and surgical indications. It was concluded that a diagnosis can be made on the basis of subependymal calcification but not on the basis of cortical calcifications or low density lesions alone. Enhancing lesions, especially at the foramen of Munro, must be considered to be tumors and should be excised if there are symptoms of obstruction. The transcallosal approach is preferred. Asymptomatic enhancing lesions may be followed by periodic scans; if no enhancing lesions are present routine follow-up scans do not appear to be useful.