Posterior approach for anteriorly located cervical spinal cord hemangioblastomas: technical note

Veken, Jorn Van Der; Gläsker, Sven; Vougioukas, Vassilis; Velthoven, Vera Van

doi:10.3171/2018.1.spine171108

Cited by 5 publications

(5 citation statements)

References 11 publications

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“…A recent article also described a posterior approach to manage anterior intramedullary cystic hemangioblastomas because drawbacks associated with the anterior approach can be avoided. 8 We agreed with these authors that a large pseudocyst not only provides a safe working corridor to the tumor but also offers extra working space after releasing the cyst contents. In the present case, these features made it possible for en bloc removal of the tumor via a small bony window through the cervical lamina and preservation of a bone “bridge” after hemi-semi-laminectomy, facilitating regrowth of the lamina and maintenance of spinal stability as evidenced by our follow-up CT.…”

Section: Discussionsupporting

confidence: 78%

Surgical management of a cervical intramedullary hemangioblastoma presenting with intracystic hemorrhage by hemi-semi-laminectomy via a posterior approach

Jiang

Chen

et al. 2019

J Int Med Res

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Background and Importance Cervical spinal cord hemangioblastoma with intracystic hemorrhage is a rare entity and presents a challenge for clinicians with regard to its timely diagnosis and appropriate treatment. Case Presentation A 35-year-old man presented with sudden-onset acute and progressive neck pain and severe radicular pain in his left upper limb. Motor weakness and numbness in the left upper and lower limbs with gait ataxia followed 2 days later. His initial diagnosis was acute myelitis, and he was treated with glucocorticoids for 2 weeks. Follow-up contrast-enhanced magnetic resonance imaging (MRI) suggested a spinal cystic hemangioblastoma with intracystic hemorrhage at the C3-4 level. The tumor was totally removed by minimally invasive unilateral hemi-semi-laminectomy via a posterior transcystic approach. The postoperative course was uneventful, and postoperative MRI revealed no residual tumor. The patient showed full neurological recovery at the 1.5-year follow-up, and computed tomography with a volume-rendering technique showed regrowth of the left C3 lamina. Conclusion Close MRI follow-up and thin-section imaging are invaluable for the timely diagnosis of spinal hemangioblastoma with intracystic hemorrhage, which was safely removed via minimally invasive microsurgery in the present case.

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Section: Discussionsupporting

confidence: 78%

Surgical management of a cervical intramedullary hemangioblastoma presenting with intracystic hemorrhage by hemi-semi-laminectomy via a posterior approach

Jiang

Chen

et al. 2019

J Int Med Res

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“…Intraoperative neuromonitoring is a further safety tool to monitor nerve function during surgery [ 42 , 52 ]. Neuromonitoring is especially helpful for tumors with relation to the cranial nerves, the brainstem, or the fourth ventricle to enable the surgeon for adjusting the surgical strategy.…”

Section: State-of-the-art Surgical Techniquesmentioning

confidence: 99%

“…Neuromonitoring is especially helpful for tumors with relation to the cranial nerves, the brainstem, or the fourth ventricle to enable the surgeon for adjusting the surgical strategy. In intramedullary hemangioblastoma, a stimulation probe can be used to identify the corticospinal tract and dorsal column to facilitate transmedullary access to ventrally located hemangioblastomas and to avoid substantial motor deficits [ 52 , 53 ].…”

Section: State-of-the-art Surgical Techniquesmentioning

confidence: 99%

Hemangioblastoma and von Hippel-Lindau disease: genetic background, spectrum of disease, and neurosurgical treatment

et al. 2020

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Introduction Hemangioblastomas are rare, histologically benign, highly vascularized tumors of the brain, the spinal cord, and the retina, occurring sporadically or associated with the autosomal dominant inherited von Hippel-Lindau (VHL) disease. Children or adults with VHL disease have one of > 300 known germline mutations of the VHL gene located on chromosome 3. They are prone to develop hemangioblastomas, extremely rarely starting at age 6, rarely at age 12–18, and, typically and almost all, as adults. There is a plethora of VHL-associated tumors and cysts, mainly in the kidney, pancreas, adrenals, reproductive organs, and central nervous system. Due to a lack of causal treatment, alleviation of symptoms and prevention of permanent neurological deficits as well as malignant transformation are the main task. Paucity of data and the nonlinear course of tumor progression make management of pediatric VHL patients with hemangioblastomas challenging. Methods The Freiburg surveillance protocol was developed by combining data from the literature and our experience of examinations of > 300 VHL patients per year at our university VHL center. Results Key recommendations are to start screening of patients at risk by funduscopy with dilated pupils for retinal tumors with admission to school and with MRI of the brain and spinal cord at age 14, then continue biannually until age 18, with emergency MRI in case of neurological symptoms. Indication for surgery remains personalized and should be approved by an experienced VHL board, but we regard neurological symptoms, rapid tumor growth, or critically large tumor/cyst sizes as the key indications to remove hemangioblastomas. Since repeated surgery on hemangioblastomas in VHL patients is not rare, modern neurosurgical techniques should encompass microsurgery, neuronavigation, intraoperative neuromonitoring, fluorescein dye-based intraoperative angiography, intraoperative ultrasound, and minimally invasive approaches, preceded in selected cases by endovascular embolization. Highly specialized neurosurgeons are able to achieve a very low risk of permanent morbidity for the removal of hemangioblastomas from the cerebellum and spinal cord. Small retinal tumors of the peripheral retina can be treated by laser coagulation, larger tumors by cryocoagulation or brachytherapy. Conclusion We consider management at experienced VHL centers mandatory and careful surveillance and monitoring of asymptomatic lesions are required to prevent unnecessary operations and minimize morbidity.

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“…Although the precise pathogenesis remains unclear, it is known that lesions can occur in atypical locations. Notably, all three patients with ventral hemangioblastomas reported by Van Der Veken were diagnosed with VHL, as were the eight patients with ventral hemangioblastomas studied by Pluta et al 23,30) . Ventral hemangioblastomas have been reported to result in worse outcomes in 33 to 80% of cases, likely due to their association with the anterior spinal artery and the difficulty of surgical access 15,23) .…”

Section: Discussionmentioning

confidence: 80%

Prognostic Factors of Spinal Intramedullary Hemangioblastoma : Analysis of Surgical Outcomes and Tumor Characteristics

Jang,

Moon,

Kim

et al. 2024

J Korean Neurosurg Soc

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Spinal intramedullary hemangioblastoma is a rare and highly vascularized benign tumor.The characteristics of the tumor, its corresponding location, and surgical outcomes remain unknown.The purpose of this study was to identify risk factors and strategies for neurologic deterioration following hemangioblastoma surgery.Methods : A comprehensive retrospective analysis was undertaken to evaluate patients who underwent surgical intervention for intramedullary hemangioblastoma at our institution from 1993 to 2022.Patients with at least one year of follow-up data were included. The analysis covered patient demographics, pre-and post-operative Modified McCormick Scale (MMCS), tumor location, and tumor size.Results : This study included 25 cases. One-year after surgery, neurological deterioration was observed in 5 (20.0%) cases, and neurological improvement was found in 9 (36.0%) cases. Five cases were ventrally located, and twelve cases were dorsally located. Ventrally located cases were larger in tumor axial size (p = 0.029) than dorsal location tumors, resulting in poorer follow-up MMCS and a higher prevalence of von Hippel-Lindau syndrome (VHL) (p = 0.042). Three of them were confirmed to be supplied by the anterior spinal artery. In the case of dorsally located cases, there was no neurologic deterioration. Conclusion :In intramedullary spinal cord hemangioblastomas, cases located ventrally had a higher incidence of neurological deterioration following surgery than those located dorsally or in intramedullary extramedullary cases. Ventrally located hemangioblastomas were larger than those in other locations. They were mainly supplied by the anterior spinal artery in VHL patients.

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Posterior approach for anteriorly located cervical spinal cord hemangioblastomas: technical note

Cited by 5 publications

References 11 publications

Surgical management of a cervical intramedullary hemangioblastoma presenting with intracystic hemorrhage by hemi-semi-laminectomy via a posterior approach

Surgical management of a cervical intramedullary hemangioblastoma presenting with intracystic hemorrhage by hemi-semi-laminectomy via a posterior approach

Hemangioblastoma and von Hippel-Lindau disease: genetic background, spectrum of disease, and neurosurgical treatment

Prognostic Factors of Spinal Intramedullary Hemangioblastoma : Analysis of Surgical Outcomes and Tumor Characteristics

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