Risk of Hemorrhage in Hemangioblastomas of the Central Nervous System

Gläsker, Sven; Velthoven, Vera Van

doi:10.1227/01.neu.0000163250.71951.18

Cited by 98 publications

(80 citation statements)

References 20 publications

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“…6) Although spontaneous hemorrhage is a very uncommon event in the natural history of HB, 4,6,13) uncontrollable intraoperative hemorrhage sometimes occurs. Endovascular embolization of the feeding artery and subsequent operative resection are the recommended procedures, because preoperative embolization can control the arterial supply and reduce tumor vascularity.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Endovascular Embolization for Hemangioblastoma in the Posterior Fossa

Sakamoto

Ishikawa

Nakai

et al. 2012

Neurol. Med. Chir.(Tokyo)

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Intracranial hemangioblastomas (HBs) are hypervascular neoplasms mainly located in the posterior fossa of the central nervous system. Preoperative embolization of the feeding arteries is one proposal for reduction of intraoperative hemorrhage, although indications for the procedures should be evaluated carefully due to the potential complications. This retrospective study investigated clinical outcomes and complications of 15 patients with HBs in the posterior fossa to evaluate the safety and effectiveness of endovascular procedures as well as angiographical procedures. Surgical excision without presurgical embolization was performed in 8 cases, and excision with presurgical embolization was performed in 7 cases, using Guglielmi detachable coils with or without polyvinyl alcohol (GDC ± PVA) in 4 cases and only n-butyl 2-cyanoacrylate (NBCA) in 3 cases. The embolization was applied for selected cases in which feeding arteries were located in a deep site and hard to coagulate surgically. Partial embolization was achieved in 5 cases, and all feeders were successfully embolized in 2 cases. Total removal was achieved in 12 cases, and subtotal/partial removal was achieved in 3 cases. Subarachnoid hemorrhage with intratumoral hemorrhage occurred in 1 case during the angiographic procedure and in 1 case during the embolization procedures. The mean volume of intraoperative blood loss was clearly less in the NBCA group than in the GDC ± PVA group. HBs are mainly located in the posterior cranial fossa, so the risk of severe clinical complication may be high if vascular problems occur. In our series, presurgical embolization using NBCA made tumor removal safe and reduced bleeding volume in posterior fossa HBs.

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Section: Discussionmentioning

confidence: 99%

Preoperative Endovascular Embolization for Hemangioblastoma in the Posterior Fossa

Sakamoto

Ishikawa

Nakai

et al. 2012

Neurol. Med. Chir.(Tokyo)

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“…In particular, when performing embolization with solid embolization materials, uneven intra-tumor embolization related to the large capillary floors of cerebellar hemangioblastomas may lead to an imbalance in the intra-tumor capillary floor pressure, causing intra-tumor hemorrhage. 9) On the other hand, a study reported that the incidence of hemorrhagic complications after embolization with liquid embolization materials was lower than after embolization with granular embolization materials. 10) In this study, prior to tumor resection of cerebellar hemangioblastomas, we performed embolization using the plug and push technique after diluting NBCA with oily contrast medium so that its adhesiveness may be reduced.…”

Section: Resultsmentioning

confidence: 99%

Preoperative Embolization of Cerebellar Hemangioblastomas with a Liquid Embolic Material (NBCA) by the “Plug and Push” Technique

Shimizu

Suenaga

Abe

et al. 2018

JNET

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“…16) Only 17 cases of hemangioblastoma associated with SAH have been reported 2,3,5,6,8,9,13,16,18,20,21,27,29) (Table 1). The characteristic symptoms of spinal SAH are severe pain along the spinal axis (neck pain and back pain/lumbago), radicular pain, paresis originating at the spinal roots, 16) or myelopathy, as seen in our present patient.…”

Section: Discussionmentioning

confidence: 99%

Intra-extradural Dumbbell-Shaped Hemangioblastoma Manifesting as Subarachnoid Hemorrhage in the Cauda Equina

Nishimura

Hara

Natsume

et al. 2012

Neurol. Med. Chir.(Tokyo)

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A 56-year-old man presented with a rare intra-extradural dumbbell-shaped hemangioblastoma in the lumbar spine associated with von Hippel-Lindau (VHL) disease manifesting as subarachnoid hemorrhage. The tumor, which was exiting at the right L2-3 intervertebral foramen, was removed successfully by total facetectomy and posterior spinal fusion at the L2-3 segment. Nine years later, a recurrent tumor due to VHL was also totally removed with minimal neurological complications. Accurate diagnosis of this vascular-rich lesion is essential for developing an adequate surgical strategy. The dumbbell-shaped tumor requires total facetectomy and spinal reconstruction, and care should be taken to preserve the entire nerve root origin by only identifying the affected nerve fascicles at the origin, if possible. Postoperative adhesion must be minimized for second surgery in patients with genetic disease such as VHL, who are likely to suffer recurrence.

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Risk of Hemorrhage in Hemangioblastomas of the Central Nervous System

Cited by 98 publications

References 20 publications

Preoperative Endovascular Embolization for Hemangioblastoma in the Posterior Fossa

Preoperative Endovascular Embolization for Hemangioblastoma in the Posterior Fossa

Preoperative Embolization of Cerebellar Hemangioblastomas with a Liquid Embolic Material (NBCA) by the “Plug and Push” Technique

Intra-extradural Dumbbell-Shaped Hemangioblastoma Manifesting as Subarachnoid Hemorrhage in the Cauda Equina

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