Subependymoma of the Spine: A Systematic Review of Clinical Presentation, Diagnostic Criteria, Treatment Strategies, and Surgical Results

Introduction: Subependymomas are rare, low-grade tumors that can occur in the brain and spinal cord. Due to their rarity, the clinical characteristics, management strategies, and outcomes of spinal subependymomas (sSEs) are not well defined. This systematic review aims to analyze the available literature on sSEs to better characterize their clinical presentation, diagnostic features, treatment approaches, and long-term outcomes.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, PubMed, EMBASE, Web of Science, and Cochrane were searched to include studies of patients with histologically confirmed spinal Subependymoma (sSE). Clinical features, management strategies, and outcomes were analyzed.

Results: 31 studies reporting 44 patients met study criteria. Median age at diagnosis was 44 years, with a male predominance (57%). The most common symptoms included pain (n=22), paresthesia (n=22), and paresis (n=22). Magnetic resonance imaging (MRI) identified cord compression or adhesion in 11 patients (25%). Lesions were most commonly found in the cervical (n=17, 39%), cervical-thoracic (n=13, 30%), and thoracic spinal cord (n=7, 16%). 80% of lesions (n=35) spanned multiple vertebral levels. Surgical resection was the primary treatment strategy with gross total resection achieved in 52% (n=23). At last follow up (median = 29 months), 30% of patients (n=13) reported complete resolution of symptoms at last follow up. Symptoms were improved in 36% of patients (n=16), stable in 30% (n=13), and worsened in 5% (n=2). Recurrence was only reported in 4 patients (9%), and only one patient was deceased (3%) due to secondary causes.

Conclusion : Spinal subependymomas predominantly affect middle-aged males and commonly present with pain, weakness, and paresthesia. Surgical resection is the primary treatment, with gross total resection achieved in over half the number of reported cases. Outcomes were generally favorable, with most patients experiencing symptom improvement or resolution. Recurrence rates were low, and overall surgical mortality was rare.