Imaging diagnosis and the role of endovascular embolization treatment for vascular intraspinal tumors

Santos, Marlise P. dos; Zhang, Jingwen; Ghinda, Diana; Glikstein, Rafael; Agid, Ronit; Rodesch, Georges; Tampieri, Donatella; terBrugge, Karel G.

doi:10.3171/2015.5.focus1514

Cited by 18 publications

(9 citation statements)

References 98 publications

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“…Angiogenesis is the process of sprouting new vessels from pre‐existing vessels and is a key driver of growth and development of a variety of tumors . HB is a highly vascularized tumor, which urges sometimes even embolization prior to surgery due to its extensive blood vessels . Despite HB being a benign and non‐metastatic tumor, a complete surgical resection is often difficult due to the multifocal distribution of this tumor, especially in VHL‐associated cases.…”

Section: Discussionmentioning

confidence: 99%

“…6,8 HB is a highly vascularized tumor, which urges sometimes even embolization prior to surgery due to its extensive blood vessels. 26 Despite HB being a benign and non-metastatic tumor, a complete surgical resection is often difficult due to the multifocal distribution of this tumor, especially in VHL-associated cases. Considering the massively vascularized feature of this tumor, anti-angiogenic therapy as an alternative or combinational therapy with surgery would be desired.…”

Section: Discussionmentioning

confidence: 99%

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Study of angiogenic signaling pathways in hemangioblastoma

et al. 2016

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Hemangioblastoma (HB) is mainly located in the brain and the spinal cord. The tumor is composed of two major components, namely neoplastic stromal cells and abundant microvessels. Thus, hyper-vascularization is the hallmark of this tumor. Despite the identification of germline and/or epigenetic mutations of Von Hippel Lindau (VHL) gene as an important pathogenic mechanism of HB, little is known about the molecular signaling involved in this highly vascularized tumor. The present study investigated the key players of multiple angiogenic signaling pathways including VEGF/VEGFR2, EphB4/EphrinB2, SDF1α/CXCR4 and Notch/Dll4 pathways in surgical specimens of 22 HB. The expression of key angiogenic factors was detected by RT -PCR and Western blot. Immunofluorescent staining revealed the cellular localization of these proteins. We demonstrated a massive upregulation of mRNA levels of VEGF and VEGFR2, CXCR4 and SDF1α, EphB4 and EphrinB2, as well as the main components of Dll4-Notch signaling in HB. An increase in the protein expression of VEGF, CXCR4 and the core-components of Dll4-Notch signaling was associated with an activation of Akt and Erk1/2 and accompanied by an elevated expression of PCNA. Immuofluorescent staining revealed the expression of VEGF and CXCR4 in endothelial cells as well as in tumor cells. Dll4 protein was predominantly found in tumor cells, whereas EphB4 immunoreactivity was exclusively detected in endothelial cells. We conclude that multiple key angiogenic pathways were activated in HB, which may synergistically contribute to the abundant vascularization in this tumor. Identification of these aberrant pathways provides potential targets for a possible future application of anti-angiogenic therapy for this tumor, particularly when a total surgical resection becomes difficult due to the localization or multiplicity of the tumor.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Study of angiogenic signaling pathways in hemangioblastoma

et al. 2016

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“…Early diagnosis is critical because the long-term spinal cord compression may lead to permanent loss of function. Detailed physical examination combined with MRI has a higher diagnostic value ( 6 ). MRI often showed intradural extramedullary circular, or dumbbell-shaped mass, T1WI showed the slightly lower signal, equal signal or equally-low mixed signal, and T2WI mostly showed high signal or mixed signal, and cystic change and necrosis might occur ( 7 ).…”

Section: Discussionmentioning

confidence: 99%

“…In this group, 16 cases underwent MRI enhanced scan, among which 6 cases showed the significant enhancement and 10 cases showed the irregular edge enhancement. It is not difficult to be diagnosed as intraspinal tumor, but its nature is hard to be defined before operation, and intraspinal neurilemmoma should be distinguished from meningioma, neurofibroma, teratoma and metastatic tumor ( 4 , 6 ). Pre-operative prediction of tumor nature is essential for intraoperative operation and post-operative recovery.…”

Section: Discussionmentioning

confidence: 99%

Experience of operative treatment in 27 patients with intraspinal neurilemmoma

Weng

Zhou

et al. 2017

Oncology Letters

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To investigate the clinical outcomes of posterior laminectomy on intraspinal neurilemmoma. Twenty-seven patients with intraspinal neurilemmoma admitted to the Second People's Hospital of Changzhou Affiliated to Nanjing Medical University from January 2010 to October 2015 were selected, and they received posterior laminectomy, and there were 5 patients whose nerve root and tumor were removed together because they could not be separated; 17 patients receiving total laminectomy or semi-laminectomy combined with facetectomy on the affected side were treated with spinal dynamic pedicle screw fixation or replantation of lamina or bone graft fusion and internal fixation. The patients were followed up regularly to observe the clinical outcomes after operation. The spinal stability and bone graft fusion were observed via X-ray film in review. Whether there was tumor recurrence was observed via MRI in review according to the individual condition. The operation time was 2.5–8 h (4.2 h on average). The intraoperative blood loss was 420–1,500 ml (760 ml on average). Tumors in 26 patients were totally resected, and tumor in 1 patient was partially resected due to tumor tissue invasion against the anterior sacral vascular plexus. All patients were pathologically confirmed as neurilemmoma after operation. Ten patients suffered from cerebrospinal fluid leakage in different degrees after operation. During the follow-up for 6–75 months after operation, clinical symptoms and neurological functions of all patients were significantly improved; there was 1 case of tumor residual and no recurrence. During the follow-up, the internal fixation in all patients receiving internal fixation of spine was stable with no vertebral instability. Posterior laminectomy can achieve satisfactory clinical outcomes in the treatment of intraspinal neurilemmoma. Internal fixation is needed to reestablish spinal stability during operation for those patients with great damage to spinal stability.

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“…The peak of incidence is in the 5-th decade, with male predominance [11]. Clinical presentation is largely non-specific [8]. Most cases are located extramedullary and intradural.…”

Section: Introductionmentioning

confidence: 99%

Paragangliomas of the spine: a retrospective case series in a national reference French center

et al. 2019

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Primary paragangliomas (PG) of the spine are extremely rare entities. The present study reviews our experience over a period of 30 years. Methods: This is a retrospective, single center, observational study. Patients treated for a spinal PG with confirmed anatomopathological diagnosis were included. The McCormick classification was used as a reference for clinical evaluation. Follow-up MRI and clinical assessment took place at 6 weeks, 3 months, 6 months and one year after surgery and on yearly basis after. Results: Six cases have been operated in our institution. The mean age was 37.8 (median 35.5, 30-53). The mean follow-up period was 9.6 years (median 9.5, 1-23). Preoperative duration of symptoms varied between a few hours to 4 years. Low back pain was most common sign. One presented with hemorrhage and acute onset of paraplegia. All patients underwent single surgery, with the exception of one case, which had two surgeries on the same anatomical site and a third surgery on another location of the same tumor type. Preoperatively, McCormick scale was I in four cases, and II and IV in one case, respectively. Postoperatively, all patients in McCormick I retained the same class; one patient in McCormick II passed to McCormick III; the case in McCormick IV recovered to McCormick II. Five of eight surgeries achieved total resection, while two surgeries accomplished a partial microsurgical excision and one a gross total resection. Three patients had spinal leptomeningeal dissemination. Two of them benefited from extended spine radiotherapy, while the other of a "wait-and-scan" policy. Spinal leptomeningeal dissemination was stable in all patients at last follow-up. Conclusion: We consider surgery as primary treatment in all PG. In our experience, preoperative diagnosis is difficult and caution must be taken to perioperative course in these cases. We do not routinely perform postoperative radiation if there is a residual tumor. We regularly perform clinical and radiological follow-up, so as to be able to document recurrent cases, which have been reported even up to 30 years after primary surgical excision.

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Imaging diagnosis and the role of endovascular embolization treatment for vascular intraspinal tumors

Cited by 18 publications

References 98 publications

Study of angiogenic signaling pathways in hemangioblastoma

Study of angiogenic signaling pathways in hemangioblastoma

Experience of operative treatment in 27 patients with intraspinal neurilemmoma

Paragangliomas of the spine: a retrospective case series in a national reference French center

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