Surgical management of intracranial subependymomas.

BACKGROUND: Intracranial subependymomas are rare, slow-growing and usually non-invasive tumors. The aim of this study was to analyze our experience with the surgical treatment of intracranial subependymomas.
METHODS: Between 1991 and 2007, 11 patients with intracranial subependymomas had surgery in our institution. Mean age of the patients was 54.4 years (ranging from 40 to 85 years).
RESULTS: Tumors were located in the fourth ventricle in seven patients and in the lateral ventricle in four patients. Most patients presented with symptoms related to intracranial hypertension and/or cerebellar signs and symptoms (headache: eight patients; dizziness: six patients; nausea: six patients; gait ataxia: four patients), one patient with cognitive decline and flattened affect, and one patient with a hemiparesis. Six patients presented with hydrocephalus, but only one needed a permanent cerebrospinal fluid (CSF) shunt. Complete removal of the tumor was possible in eight cases. Following surgery, only one patient experienced a permanent drop of his Karnofsky Performance Index (from 70 to 60). Median follow-up was 37 months. There were no true recurrences during follow-up. A second surgery was required 7 years after the first operation for progression of an incompletely resected tumor.
CONCLUSIONS: Removal of symptomatic subependymomas can be performed safely. Prognosis is excellent after a complete resection. The potential for a surgical cure, low surgical complication rates and the risk of undertreatment of a more aggressive tumor together may justify surgery for asymptomatic lesions.