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Chen X, Guo H, Zhang J, Ye J, Wang S, Jiang H, Mu Q, Wang X. En Bloc Resection for Spinal Cord Hemangioblastomas: Surgical Technique and Clinical Outcomes. J Neurol Surg A Cent Eur Neurosurg 2024; 85:577-584. [PMID: 37992732 PMCID: PMC11452231 DOI: 10.1055/s-0043-1776707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/31/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Spinal cord hemangioblastomas are rare benign and highly vascular tumors that develop either sporadically or as part of von Hippel-Lindau (VHL) disease. Generally, complete resection without significant neurologic deficit remains considerably challenging due to the risk of massive bleeding. The current study therefore aimed to describe en bloc resection of spinal cord hemangioblastomas according to the typical anatomical structures of peripheral lesions and evaluate the neurofunctional prognosis of this technique. METHODS A total of 39 spinal cord hemangioblastomas from a series of 19 patients who underwent en bloc resection were retrospectively analyzed. In all cases, clinical and radiologic characteristics, as well as surgical tenets, were retrospectively determined and analyzed. Short- and long-term outcomes were analyzed using the McCormick grade and Odom's criteria. Factors significantly associated with poor neurologic function after en bloc resection were also determined. RESULTS All 39 spinal cord hemangioblastomas, including 28 intramedullary, 2 intramedullary-extramedullary, and 9 extramedullary lesions, were located dorsally or dorsolaterally (100.0%). The most common lesion location was the thoracic segment (53.8%), with most of the lesions being accompanied by syringomyelia (94.7%). Long-term follow-up (mean: 103 ± 50.4 months) for prognosis determination revealed that 88.2% (15/17) of all cases had stable or improved neurofunctional outcomes according to the McCormick grade and Odom's criteria. Only one case with VHL disease developed recurrence 4 years after surgery. Additionally, statistical analysis showed that VHL disease was an independent prognostic factor associated with deteriorating neurologic function (p = 0.015). CONCLUSIONS En bloc resection facilitated satisfactory long-term functional outcomes in patients with spinal cord hemangioblastomas. Given that VHL disease was identified as a predictor of poor long-term outcomes, regular long-term follow-up of patients with VHL-associated spinal cord hemangioblastoma seems necessary.
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Affiliation(s)
- Xiaofeng Chen
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
- Institute of Brain Science, Harbin Medical University, Harbin, Heilongjiang, China
- Institute of Neuroscience, Sino-Russian Medical Research Center, Harbin Medical University, Harbin, Heilongjiang, China
| | - Hua Guo
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jianli Zhang
- Department of Neurology, Xiamen Fifth Hospital, Xiamen, Fujian, China
| | - Junyi Ye
- Department of Neurosurgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Shurong Wang
- Department of Neurology, Hainan Medical University, Haikou, Hainan, China
| | - Haiping Jiang
- Department of Neurosurgery, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Qingchun Mu
- Department of Neurosurgery, The People's Hospital of Gaozhou of Guangdong Medical University, Maoming, Guangdong, China
| | - Xiaoxiong Wang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
- Institute of Brain Science, Harbin Medical University, Harbin, Heilongjiang, China
- Institute of Neuroscience, Sino-Russian Medical Research Center, Harbin Medical University, Harbin, Heilongjiang, China
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Tropeano MP, Rossini Z, Franzini A, Baram A, Creatura D, Raspagliesi L, Pessina F, Fornari M. Predictive Factors of Long-Term Neurologic Outcome and Progression-Free Survival in Intramedullary Spinal Cord Tumors: A 10-year Single-Center Cohort Study and Review of the Literature. World Neurosurg 2024; 187:e94-e106. [PMID: 38608817 DOI: 10.1016/j.wneu.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Intramedullary spinal cord tumors (IMSCTs) are a rare subgroup of neoplasms, encompassing both benign, slow-growing masses, and malignant lesions; radical surgical excision represents the cornerstone of treatment for such pathologies regardless of histopathology, which, on the other hand, is a known predictor of survival and neurologic outcome postsurgery. The present study aims to investigate the relevance of other factors in predicting survival and long-term functional outcomes. METHODS We conducted a review of current literature on functional outcomes of IMSCTs, as well as a 10-years prospective analysis of a wide cohort of patients with diagnosis of IMSCTs who underwent surgical resection at our institution. RESULTS Our series encompasses 60 patients with IMSCTS, among which 36 ependymomas, 6 cavernous angiomas, 5 hemangioblastomas, 6 WHO Grade I-IV astrocytomas, 3 intramedullary spinal metastases and 4 miscellaneous tumors. GTR was achieved in 76,67% of patients, with high preoperative McCormick grade, syringomyelia and changes at neurophysiologic monitoring being the strongest predictors at multivariate analysis (P = 0.0027, P = 0.0017 and P = 0.001 respectively). CONCLUSIONS Consistently with literature, preoperative neurologic function is the most important factor predicting long-term functional outcome (0.17, CI 0.069-0.57 with P = 0.0018), advocating for early surgery in the management of IMSCTs, whereas late complications such as myelopathy and neuropathic pain were present regardless of preoperative function.
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Affiliation(s)
- Maria Pia Tropeano
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Zefferino Rossini
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Andrea Franzini
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Ali Baram
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Donato Creatura
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.
| | - Luca Raspagliesi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Federico Pessina
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Maurizio Fornari
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
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Takeshima Y, Takami H, Endo T, Mizuno M, Hida K. Comparison of the Recurrence and Surgical Outcome of Spinal Hemangioblastoma in Sporadic and Von Hippel-Lindau Diseases: A Subanalysis of a Nationwide Study by the Neurospinal Society of Japan. Neurospine 2023; 20:756-765. [PMID: 37350167 PMCID: PMC10562215 DOI: 10.14245/ns.2346368.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/09/2023] [Accepted: 06/18/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVE This study aimed to clarify the relationship between recurrence and the extent of resection in surgery for intramedullary spinal hemangioblastoma (sHB) and its impact on von Hippel-Lindau (vHL) disease. METHODS Data on sHB cases followed up for at least 6 months after surgery were extracted from a nationwide registry of 1,033 consecutive spinal intramedullary tumors surgically treated between 2009 and 2020, and were retrospectively categorized into a sporadic or vHL group. The diagnosis of vHL disease was made at each institution based on clinical findings. RESULTS A total of 168 patients (sporadic group, 101; vHL group, 67) were included in the study. Compared with the sporadic group, the vHL group had a younger onset (45.4 ± 16.8 years vs. 39.6 ± 14.1 years, p = 0.02), more preoperative motor (47.5% vs. 68.7%, p < 0.01) and gait (37.6% vs. 61.2%, p < 0.01) impairments, and more patients with worsening neurological symptoms at discharge (p = 0.02). The gross total resection (GTR) rates and the recurrence rates were not statistically different between the sporadic and the vHL groups. GTR significantly improved recurrence-free survival compared to non-GTR in all patient analysis (p < 0.01) but this trend was not observed in the sporadic group. Physical functional improvement from discharge to 6 months after surgery was observed in the sporadic group (p < 0.01) but not in the vHL group. CONCLUSION A high GTR rate may sufficiently decrease susceptibility to recurrence, especially in patients with sHB with vHL. In sporadic sHB, postoperative functional improvement can be expected, and the long-term functional prognosis is favorable.
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Affiliation(s)
| | - Hirokazu Takami
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Toshiki Endo
- Department of Neurosurgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Masaki Mizuno
- Department of Minimum-Invasive Neurospinal Surgery, Mie University, Tsu, Japan
| | - Kazutoshi Hida
- Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan
| | - for the Investigators of Intramedullary Spinal Cord Tumors in the Neurospinal Society of Japan
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo Hospital, Tokyo, Japan
- Department of Neurosurgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan
- Department of Minimum-Invasive Neurospinal Surgery, Mie University, Tsu, Japan
- Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan
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Quiceno E, Hussein A, Pico A, Abdulla E, Bauer IL, Nosova K, Moniakis A, Khan MA, Farhadi DS, Prim M, Baaj A. Indications for Fusion With Intradural Spine Tumor Resection in Adults: A Systematic Review and Meta-analysis. World Neurosurg 2023; 176:21-30. [PMID: 37080455 DOI: 10.1016/j.wneu.2023.04.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND The evidence for instrumented fusion in the setting of degenerative, traumatic, or congenital deformity is well established. Data on fusion indications in intradural spinal tumors (IDST) are scarce and reduced to retrospective studies. The objective of this work is to systematically review the published literature since 2015 and analyze the change of practice patterns for stabilization and fusion after intradural tumor resection in adults. METHODS A systematic literature review was performed via PubMed with the terms: "intradural spinal tumors", "intramedullary spinal tumors", and "intraspinal tumors". The analysis was limited to adult patients with IDST and studies with more than 10 patients. Data on the proportion of patients who underwent instrumentation and had postoperative deformity was pooled in a meta-analysis. RESULTS A total of 1073 articles were identified and 47 papers were selected. All the studies were retrospective series and a total of 2473 patients were included. The follow-up ranged from 1 to 96 months, the pooled spinal fixation rate was 6% (95% CI 4.5%-7.6%), the pooled laminoplasty rate was 14.4% (95% CI 5.9%-23%), the pooled rate of postoperative deformity or malalignment in patients with a follow up of at least 6 months was 2.1% (95% CI 1.2%-3%) and just 7 patients were reoperated due to progressive deformity. CONCLUSIONS Based on existing evidence, the rate of fusion during resection of intradural spinal tumors is low. Prophylactic fixation is often unnecessary and only indicated in unique cases that require extensive bony resection.
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Affiliation(s)
- Esteban Quiceno
- Department of Neurosurgery, Banner University Medical Center, Phoenix, AZ, USA; Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, AZ, USA.
| | - Amna Hussein
- Department of Neurosurgery, Banner University Medical Center, Phoenix, AZ, USA; Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Annie Pico
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Ebtesam Abdulla
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Isabel L Bauer
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Kristin Nosova
- Department of Neurosurgery, Banner University Medical Center, Phoenix, AZ, USA; Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Alexandros Moniakis
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Monis Ahmed Khan
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Dara S Farhadi
- Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Michael Prim
- Department of Neurosurgery, Banner University Medical Center, Phoenix, AZ, USA
| | - Ali Baaj
- Department of Neurosurgery, Banner University Medical Center, Phoenix, AZ, USA; Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, AZ, USA
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Hidaka T, Ikawa F, Michihata N, Onishi S, Matsuda S, Ozono I, Oku S, Takayanagi S, Fushimi K, Yasunaga H, Kurisu K, Horie N. Perioperative Surgical Risks in Patients With Hemangioblastomas: A Retrospective Nationwide Review in Japan. World Neurosurg 2023; 170:e21-e27. [PMID: 36356840 DOI: 10.1016/j.wneu.2022.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The perioperative risk of sporadic hemangioblastomas (HBs) and von Hippel-Lindau disease (VHL)-associated hemangioblastomas (VHL-associated HBs) remains unclear due to the rare prevalence of HB. Therefore, this study aimed to clarify risk factors for better surgical management of patients with HBs. METHODS A retrospective analysis of surgically treated HB patients registered in the Diagnosis Procedure Combination database of Japan, between 2010 and 2015, was performed. Age, sex, sporadic HBs or VHL-associated HBs, medical history, tumor location, hospital case load, postoperative complications, and Barthel index (BI) deterioration were assessed. We also evaluated the outcomes and factors of perioperative BI deterioration. RESULTS In total, 676 patients with 609 intracranial lesions, 64 spinal lesions, and 3 with both types were eligible. Among them, 618 and 58 patients had sporadic HBs and VHL-associated HBs, respectively. The rates of perioperative BI deterioration were 12.5% and 12.2% for sporadic HBs and VHL-associated HBs, respectively. Perioperative mortality was 1.8% and 0% for sporadic HBs and VHL-associated HBs, respectively. Male sex, old age, high hospital case load, and medical history of diabetes mellitus were significantly associated with perioperative BI deterioration in all cases and sporadic HBs. Only medical history of diabetes mellitus was a significant risk factor for perioperative BI deterioration in VHL-associated HBs. CONCLUSIONS No differences in perioperative BI deterioration rates between sporadic HBs and VHL-associated HBs were found. However, different risk factors for perioperative BI deterioration were identified. Consideration of these risk factors is recommended in all patients undergoing surgery for HB.
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Affiliation(s)
- Toshikazu Hidaka
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Fusao Ikawa
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan; Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Nobuaki Michihata
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Shumpei Onishi
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shingo Matsuda
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Iori Ozono
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Shinichiro Oku
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | | | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Chugoku Rosai Hospital, Kure, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Butenschoen VM, Schwendner M, Hubertus V, Onken J, Koegl N, Mohme T, Maurer S, Boeckh-Behrens T, Eicker SO, Thomé C, Vajkoczy P, Czabanka M, Meyer B, Wostrack M. Preoperative angiographic considerations and neurological outcome after surgical treatment of intradural spinal hemangioblastoma: a multicenter retrospective case series. J Neurooncol 2023; 161:107-115. [PMID: 36566460 PMCID: PMC9886638 DOI: 10.1007/s11060-022-04213-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/07/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE Intradural spinal hemangioblastomas are rare highly hypervascularized benign neoplasms. Surgical resection remains the treatment of choice, with a significant risk of postoperative neurological deterioration. Due to the tumor infrequency, scientific evidence is scarce and limited to case reports and small case series. METHODS We performed a retrospective multicenter study including five high-volume neurosurgical centers analyzing patients surgically treated for spinal hemangioblastomas between 2006 and 2021. We assessed clinical status, surgical data, preoperative angiograms, and embolization when available. Follow-up records were analyzed, and logistic regression performed to assess possible risk factors for neurological deterioration. RESULTS We included 60 patients in Germany and Austria. Preoperative angiography was performed in 30% of the cases; 10% of the patients underwent preoperative embolization. Posterior tumor location and presence of a syrinx favored gross total tumor resection (93.8% vs. 83.3% and 97.1% vs. 84%). Preoperative embolization was not associated with postoperative worsening. The clinical outcome revealed a transient postoperative neurological deterioration in 38.3%, depending on symptom duration and preoperative modified McCormick grading, but patients recovered in most cases until follow-up. CONCLUSION Spinal hemangioblastoma patients significantly benefit from early surgical treatment with only transient postoperative deterioration and complete recovery until follow-up. The performance of preoperative angiograms remains subject to center disparities.
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Affiliation(s)
- Vicki M. Butenschoen
- Department of Neurosurgery, School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Ismaningerstr. 22, 81675 Munich, Germany
| | - Maximilian Schwendner
- Department of Neurosurgery, School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Ismaningerstr. 22, 81675 Munich, Germany
| | - Vanessa Hubertus
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Julia Onken
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany ,Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Nikolaus Koegl
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Theresa Mohme
- Department of Neurosurgery, University Medical Center Hamburg Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - Stefanie Maurer
- Department of Neurosurgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Tobias Boeckh-Behrens
- Department of Neuroradiology, School of Medicine, Technical University Munich, Ismaningerstr. 22, 81675 Munich, Germany
| | - Sven O. Eicker
- Department of Neurosurgery, University Medical Center Hamburg Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany ,Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Marcus Czabanka
- Department of Neurosurgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Ismaningerstr. 22, 81675 Munich, Germany
| | - Maria Wostrack
- Department of Neurosurgery, School of Medicine, Technical University Munich, Klinikum Rechts der Isar, Ismaningerstr. 22, 81675 Munich, Germany
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Morita K, Tanaka S, Tamai S, Nakada M. Spinal hemangioblastoma with syringomyelia manifesting as neurological dysfunction progressing over the course of 17 years: A case report. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Lu HY, Jerram RM, Hoddinott KL. Long‐term outcome of a dog with surgically resected thoracic intramedullary haemangioblastoma and concurrent lumbosacral disease. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Hui Yu Lu
- Atlantic Veterinary College University of Prince Edward Island Charlottetown Prince Edward Island Canada
| | | | - Katie Leigh Hoddinott
- Atlantic Veterinary College University of Prince Edward Island Charlottetown Prince Edward Island Canada
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Feletti A, Boaro A, Giampiccolo D, Casoli G, Moscolo F, Ferrara M, Sala F, Pavesi G. Spinal hemangioblastomas: analysis of surgical outcome and prognostic factors. Neurosurg Rev 2021; 45:1645-1661. [PMID: 34825301 DOI: 10.1007/s10143-021-01696-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 11/02/2021] [Accepted: 11/11/2021] [Indexed: 11/29/2022]
Abstract
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. All cases of spinal hemangioblastomas removed at two Italian academic institutions from 1985 to 2020 were reviewed. Data about clinical presentation and symptom duration, diagnosis of VHL, surgical approach, use of IONM, duration of hospital stay, follow-up, and modified McCormick grade before and after surgery were extracted. 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 significance. Laminotomy and use of IONM were found to be associated with better outcome, although no association was found between surgery without IONM and worse outcome. 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.
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Affiliation(s)
- Alberto Feletti
- Department of Neurosciences, Biomedicine, and Movement Sciences, Institute of Neurosurgery, University of Verona, Polo Chirurgico "P. Confortini", P.le Stefani 1, 37126, Verona, Italy.
| | - Alessandro Boaro
- Department of Neurosciences, Biomedicine, and Movement Sciences, Institute of Neurosurgery, University of Verona, Polo Chirurgico "P. Confortini", P.le Stefani 1, 37126, Verona, Italy
| | - Davide Giampiccolo
- Department of Neurosciences, Biomedicine, and Movement Sciences, Institute of Neurosurgery, University of Verona, Polo Chirurgico "P. Confortini", P.le Stefani 1, 37126, Verona, Italy
| | - Giorgio Casoli
- Unit of Neurosurgery, Department of Biomedicine, Metabolic Sciences and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Moscolo
- Department of Neurosciences, Biomedicine, and Movement Sciences, Institute of Neurosurgery, University of Verona, Polo Chirurgico "P. Confortini", P.le Stefani 1, 37126, Verona, Italy
| | - Massimiliano Ferrara
- Familial Cancer Clinic and Oncoendocrinology, Veneto Institute of Oncology, IOV-IRCCS, Padova, Italy
| | - Francesco Sala
- Department of Neurosciences, Biomedicine, and Movement Sciences, Institute of Neurosurgery, University of Verona, Polo Chirurgico "P. Confortini", P.le Stefani 1, 37126, Verona, Italy
| | - Giacomo Pavesi
- Unit of Neurosurgery, Department of Biomedicine, Metabolic Sciences and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
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Marchesini N, Ricci UM, Pinna G. Sporadic cauda equina hemangioblastoma: surgical management in a pregnant woman. Br J Neurosurg 2021; 37:1-5. [PMID: 33877021 DOI: 10.1080/02688697.2021.1914820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
Hemangioblastoma is a rare benign vascular tumour of the central nervous system that occurs either sporadically or in association with Von Hippel-Lindau syndrome. Hemangioblastoma can be found throughout the central nervous system and usually present with late manifestations due to their slow growth rate. Cauda equina hemangioblastomas are extremely rare, and in the literature, no cases are reported on the surgical management of pregnant patients with this condition. We report the case of a young woman with back pain and sphincter dysfunctions in whom an L1-L2 hemangioblastoma was diagnosed. We describe the perioperative and surgical strategies we adopted to successfully treat the patient and preserve the fetus well-being.
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Affiliation(s)
- Nicolò Marchesini
- Department of Neurosurgery, Borgo Trento Hospital, University of Verona, Verona, Italy
| | - Umberto Maria Ricci
- Department of Neurosurgery, Borgo Trento Hospital, AOUI Verona, Verona, Italy
| | - Giampietro Pinna
- Department of Neurosurgery, Borgo Trento Hospital, AOUI Verona, Verona, Italy
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Etli MU, Sarıkaya C, Onen MR, Naderi S. Spinal Hemangioblastomas and Neuropathic Pain. World Neurosurg 2021; 149:e780-e784. [PMID: 33540101 DOI: 10.1016/j.wneu.2021.01.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Spinal hemangioblastomas (SHs) are rare and benign tumors. Primary symptoms include pain, hypoesthesia, and neuropathic pain (NP). Clinical symptoms may be as a result of tumor mass effect, peritumoral effect, syrinx, or venous congestion. No studies have focused on NP in SHs. The objective of this study was to review the rate and causes of NP in patients with SHs. METHODS The present study comprises a retrospective analysis of 13 patients with spinal hemangioblastomas. For the retrospective analysis of the patients, we analyzed the absence or presence of NP in the pre- and postoperative periods and its relationship with the level, location, and size of the tumor, as well as the size and location of the syrinx. RESULTS Postoperative NP was detected in 6 out of 13 patients. All 6 patients' tumors were located at the dorsal aspect of the spinal cord. There was a predominance of rostral syrinx location in patients with NP. Tumor size and level and syrinx size and level were not found to affect the occurrence of NP. CONCLUSIONS The present study shows that NP is observable in both pre- and postoperative periods. Proximity of the tumor to the dorsal root entry zone, and especially the presence of rostral syrinx, are the main factors affecting postoperative NP symptomatology. It is concluded that the combination of these factors and iatrogenic injury of anatomic pathways of NP within the spinal cord are responsible for postoperative NP.
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Affiliation(s)
- Mustafa Umut Etli
- Department of Neurosurgery, Health Sciences University, Ümraniye Training and Research Hospital, Istanbul, Turkey.
| | - Caner Sarıkaya
- Department of Neurosurgery, Health Sciences University, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Resid Onen
- Department of Neurosurgery, VM Medical Park Maltepe Hospital, Istanbul, Turkey
| | - Sait Naderi
- Department of Neurosurgery, Health Sciences University, Ümraniye Training and Research Hospital, Istanbul, Turkey
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Timonin SY, Konovalov NA. Surgical Treatment of Intramedullary Hemangioblastomas: Current State of Problem (Review). Sovrem Tekhnologii Med 2021; 13:83-94. [PMID: 35265353 PMCID: PMC8858416 DOI: 10.17691/stm2021.13.5.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Indexed: 12/25/2022] Open
Abstract
Intramedullary hemangioblastomas (HAB) refer to very rare highly vascularized vascular spinal cord tumors associated with various neurological disorders. Effective HAB therapy to a greater extent depends on diagnostic accuracy and the absence of intra- and postoperative complications. The present study is a review of publications concerned with modern diagnostic and therapeutic techniques to control spinal HAB. The authors showed that perfusion computed tomography, computed tomographic angiography, and magnetic resonance angiography can be reasonably used for diagnosis and differentiation in a number of HAB due to their high vascularization. Preoperative embolization significantly reducing intraoperative bleeding risks is highly efficient. Some authors recommend this procedure in case of large lesions and high risks of intraoperative bleeding. The review also considered intraoperative imaging of a tumor and its feeding vessels using indocyanine green providing inspectability over the total tumor resection and clear imaging of tumor vascular architecture. The advantages and restrictions of the mentioned procedures were described.
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Affiliation(s)
- S Yu Timonin
- PhD Student N.N. Burdenko National Medical Research Center for Neurosurgery, Ministry of Health of the Russian Federation, 16, 4 Tverskaya-Yamskaya St., Moscow, 125047, Russia
| | - N A Konovalov
- Professor, Corresponding Member of the Russian Academy of Sciences, Head of 10 Neurosurgery Department; Deputy Director for Science N.N. Burdenko National Medical Research Center for Neurosurgery, Ministry of Health of the Russian Federation, 16, 4 Tverskaya-Yamskaya St., Moscow, 125047, Russia
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