Clinical features and management of five patients with supratentorial subependymoma.

Subependymoma is a rare low-grade glioma of the central nervous system that is often asymptomatic and discovered incidentally. If symptomatic, however, its clinical features vary widely. We report and discuss the management of five surgical patients (two males and three females, 27-65 years old). All tumors developed supratentorially around the foramen of Monro, and their diameters ranged from 18 mm to 90 mm. Of the three symptomatic patients, one presented with sudden loss of consciousness despite having only a small tumor, while in contrast, another patient showed only gradual memory disturbance despite having a very large tumor (90 mm diameter). Two patients were asymptomatic but had ventricular dilatation. Gross total resection was achieved via either a transcortical (three patients) or an anterior transcallosal approach (two patients). No recurrence was observed during follow-up. We concluded that as surgery is the only curative treatment for subependymoma, and even a small tumor can present with sudden deterioration, we recommend early and total resection. Copyright 2009 Elsevier Ltd. All rights reserved.