A study was performed to outline the reported diagnostic and operative findings, and assess the surgical treatment outcome to clarify the best available recommendations. For this, Ovid Medline, Embase and PubMed central databases were searched from inception until January 2019 using the terms, subependymoma and spinal or cervical or thoracic. The articles were reviewed for reported spinal subependymoma cases perioperative management and treatment outcomes. In total, 49 papers provided data on 105 cases. Of these, 47 cases were reported in the last 5 years. The reported cases included2 medullary-cervical, 35 cervical, 32 cervicothoracic, 21 thoracic, 12 thoracolumbar and 3 lumbar. Spinal subependymomas typically originated from within the central spinal canal, and appeared like an intramedullary mass, often eccentric to one side. Symptoms at presentation varied between 1 month to 17 years (mean: 3.5 years, median: 2 years), and were over 3 years in 36, and over 8 years in 12 cases. Sensory symptoms were the most common, reported in 75(80%) cases, followed by weakness in 60(64%), pain in 45(48%) and sphincter disturbance in 24(25%) cases. Post-operative neurological function was reported in 78 cases.Worsening was seen in 40 cases (51%), of which, 29 (72%) had complete resection, 6 (15%) had subtotal resection and 5 (12%) had partial resection. Neurological status remained the same in 24 (30%) and improved in 14 (18%) cases.The reviewed cases report a rate of 65% total resection. Of these, 57% had worsened function after surgery. No reports of malignant transformation were there,indicating the possibility of long-term survival. The researchers further suggested exercising surgical caution if symptom progression is minimum.

Source: Neurosurg Rev. 2020 Aug;43(4):1047-1053.