Spinal hemangioblastomas: analysis of surgical outcome and prognostic factors

Abstract

Background. The prognostic factors for surgically removed spinal hemangioblastomas, the impact of VHL disease on outcome, and the role of intraoperative neuromonitoring are still not completely clear. The aim of this study was to review our experience with spinal hemangioblastomas in order to assess potential predictors of neurological outcome after surgery.Methods. All cases of spinal hemangioblastomas removed at two Italian academic institutions from 1985 to 2020 were reviewed. Data about clinical presentation and symptoms duration, diagnosis of VHL, surgical approach, use of IONM, duration of hospital stay, follow up, McCormick grade before and after surgery were extracted.Results. Sixty-one patients (31 F, 30 M) underwent 69 surgeries to remove 74 spinal hemangioblastomas (37 cervical, 32 thoracic, 5 lumbar). Improvement was found in 32.3% of cases, neurological condition remained stable in 51.6% of cases, and deteriorated in 16.1% of patients.A worsening trend in VHL patients and an improvement trend in non-VHL patients were detected, despite the lack of statistical signi cance. Laminotomy and use of IONM were found to be associated with better outcome, although no association was found between surgery without IOM and worse outcome.Conclusion. In most cases, patients affected by spinal hemangioblastomas can expect a good long-term outcome. In our experience, laminotomy seems to be associated with better outcome compared to laminectomy. While its absence is not associated with worse outcome, IONM seems to be associated with a better neurological outcome. Our study suggests that the more impaired the preoperative neurological condition, the worse the outcome.

Resection of Intramedullary Hemangioblastoma: Timing of Surgery and Its Impact on Neurological Outcome and Quality of Life

“…These results are in line with previously published studies investigating the outcome after SIMH and other intradural tumor resections [ 10 , 11 , 20 , 21 , 22 ] and highlight that severe neuronal damage would not fully recover after surgery. However, in a recent large case series, the authors had some evidence of this association but could not prove statistical significance [ 23 ].…”

“…Moreover, the results of this study suggest that the extent of resection (EOR) is higher in the case of mild neurological disorders in comparison to the case when more severe neurological deficits are preexisting, again showing the vulnerability of the spinal cord in that case. In all cases of STR in this series, surgery had to be prematurely terminated due to deterioration of IOM potentials during tumor resection [ 23 , 24 , 25 ]. In addition, even if not statistically significant in the results, patients with more severe deficits had more postoperative complications, higher blood loss and longer duration of the surgery.…”

Preoperative angiographic considerations and neurological outcome after surgical treatment of intradural spinal hemangioblastoma: a multicenter retrospective case series

“…Published literature has mentioned an association between the surgical approach and the clinical outcome [ 16 ], favoring laminotomies over laminectomies in univariate analysis. In our patient cohort, we also identified a significant association between the surgical approach and the postoperative clinical outcome.…”

Pediatric Spinal Hemangioblastomas: Clinical Features and Surgical Outcomes of 39 Cases

“…Complete resection is currently the best modality for management of adult HBs since surgery can result in improvement in more than half of adult patients. 5,9,[19][20][21][22][23] However, the experience of managing pediatric ISCM is inadequate and has mostly been derived from experience with managing adult patients. However, given that pediatric patients have a higher proportion of VHL and the unpredictable growth pattern of HBs, the indications and best approach for surgical timing in this subset of patients should be clarified.…”