Subependymoma
BASIC DESCRIPTION
- Benign, intraventricular tumor, likely arising from subependymal glial precursor cells
PATHOLOGY
- WHO grade I
- Solid, avascular, lobulated mass
- Large tumors can show calcification, hemorrhage, and cystic components
- Sporadic
- Usually arising from floor of the fourth ventricle or septum pellucidum or lateral wall of the lateral ventricle
CLINICAL FEATURES
- Afflicts middle-aged or older adults (in their fifth or sixth decade of life)
- Male gender predilection
- Common presenting symptoms:
- Usually asymptomatic
- With larger tumors, symptoms are often related to increased intracranial pressure (ie, nausea, vomiting, headaches, ataxia)
- Treatment
- Conservative management with serial imaging if asymptomatic
- If symptomatic, gross-total resection for lateral ventricular tumors and subtotal resection for fourth ventricle tumors; might require CSF shunt for hydrocephalus
- Recurrence is rare after resection
- Very good prognosis for patients with supratentorial subependymoma
IMAGING FEATURES
- General
- Well-defined, lobulated, nonenhancing ventricular mass
- Fourth ventricular tumors might grow through the foramen of Magendie
- CT
- Isodense to hypodense
- ±Calcification and cysts in larger tumors
- Usually little to no enhancement on contrast-enhanced CT imaging
- MRI
- T1WI: homogenous, hypointense to isointense relative to white matter
- T2WI: hyperintense; heterogeneous signal due to cystic components and hemorrhage in larger tumors
- FLAIR: hyperintense, no edema of adjacent brain parenchyma
- T2*/GRE/SWI: signal blooming secondary to calcification
- T1WI+C: little to no enhancement most common
IMAGING RECOMMENDATIONS
- MRI with contrast; CT imaging can be helpful for the identification of small calcifications
For more information, please see the corresponding chapter in Radiopaedia.
Contributors: Rachel Seltman, MD, and Jacob A. Eitel, MD
References
Bi Z, Ren X, Zhang J, et al. Clinical, radiological, and pathological features in 43 cases of intracranial subependymoma. J Neurosurg 2015;122:49–60. doi.org/10.3171/2014.9.JNS14155.
Chiechi MV, Smirniotopoulos JG, Jones RV. Intracranial subependymomas: CT and MR imaging features in 24 cases. AJR Am J Roentgenol 1995;165:1245–1250. doi.org/10.2214/ajr.165.5.7572512.
Hou Z, Wu Z, Zhang J, et al. Clinical features and management of intracranial subependymomas in children. J Clin Neurosci 2013;20:84–88. doi.org/10.1016/j.jocn.2012.05.026.
Louis DN, Ohgaki H, Wiestler OD, et al (eds). WHO Classification of Tumours of the Central Nervous System: Subependymoma. IARC Press, Lyon, France; 2007:70–71.
Osborn AG, Salzman KL, Jhaveri MD. Diagnostic Imaging (3rd ed). Elsevier, Philadelphia, PA; 2016.
Smith AB, Smirniotopoulos JG, Horkanyne-Szakaly I. From the radiologic pathology archives: intraventricular neoplasms: radiologic-pathologic correlation. Radiographics 2013;33:21–43. doi.org/10.1148/rg.331125192.
Silverstein JE, et al. MRI of intracranial subependymomas. J Comput Assist Tomogr 1995;19:264–267. doi.org/10.1097/00004728-199503000-00018.
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