Multiple hemangioblastomas accompanied by syringomyelia in the cerebellum and the spinal cord

Modified classification of spinal cord vascular lesions

The literature on spinal vascular malformations contains a great deal of confusing terminology. Some of the nomenclature is inconsistent with the lesions described. Based on the experience of the senior author (R.F.S.) in the treatment of more than 130 spinal cord vascular lesions and based on a thorough review of the relevant literature, the authors propose a modified classification system for spinal cord vascular lesions. Lesions are divided into three primary or broad categories: neoplasms, aneurysms, and arteriovenous lesions. Neoplastic vascular lesions include hemangioblastomas and cavernous malformations, both of which occur sporadically and familially. The second category consists of spinal aneurysms, which are rare. The third category, spinal cord arteriovenous lesions, is divided into arteriovenous fistulas and arteriovenous malformations (AVMs). Arteriovenous fistulas are subdivided into those that are extradural and those that are intradural, with intradural lesions categorized as either dorsal or ventral. Arteriovenous malformations are subdivided into extradural-intradural and intradural malformations. Intradural lesions are further divided into intramedullary, intramedullary-extramedullary, and conus medullaris, a new category of AVM. This modified classification system for vascular lesions of the spinal cord, based on pathophysiology, neuroimaging features, intraoperative observations, and neuroanatomy, offers several advantages. First, it includes all surgical vascular lesions that affect the spinal cord. Second, it guides treatment by classifying lesions based on location and pathophysiology. Finally, it eliminates the confusion produced by the multitude of unrelated nomenclatural terms found in the literature.

Cervical hemangioblastoma with a past history of subarachnoid hemorrhage

BACKGROUND

Subarachnoid hemorrhage (SAH) with a spinal origin is a rare clinical entity. The most common source of SAH is an arteriovenous malformation. Only six cases of spinal hemangioblastomas causing SAH have been reported.

CASE DESCRIPTION

This 48-year-old man had experienced severe headache 12 years earlier, which was diagnosed as SAH by computed tomography (CT) scan and lumbar puncture. However, cerebral angiography could not detect either aneurysm or arteriovenous malformation. Thereafter, he spent an uneventful life until he was incidentally diagnosed with a cervical tumor on magnetic resonance imaging (MRI) study for Meniere's disease. The tumor was situated at the cervicomedullary junction, and fed by the left vertebral artery. Histologic findings of the tumor showed features typical of hemangioblastoma.

CONCLUSIONS

We describe a case of cervical spinal extramedullary hemangioblastoma with a past history of SAH. In our case, the SAH of 12 years ago perhaps occurred from the cervicomedullary junction hemangioblastoma. Since the etiology of SAH could not be detected at the first angiography, not only follow-up reangiography, but also MRI of the spinal cord and spinal angiography could have played an important role.

Von Hippel-Lindau's disease: report of three cases and review of the literature

The authors present the autopsy findings of two related patients and the biopsy findings of a third member of the family. The oldest member was 34 years old at death and on postmortem examination he had haemangioblastomas in the retina, cerebellum, medulla and spinal cord. Other findings were renal cell carcinoma, phaechromocytoma, cysts of kidney and pancreas, hydromyelia and atypical meningiomas. His brother died when 30 years old. The autopsy revealed haemangioblastomas of cerebellum, renal cell carcinoma and a clear cell cystadenoma of epididymus. The third patient was the daughter of the first and presented with headache and dizziness. CT-scan showed a cerebellar haemangioblastoma. Epidemiological considerations on the commonest visceral and CNS lesions and a review of current diagnostic criteria are discussed.

Syringomyelia affecting the entire spinal cord secondary to primary spinal intramedullary central nervous system lymphoma

A case of syringomyelia involving the entire spinal cord secondary to a spinal intramedullary tumour is described. Cerebrospinal fluid cytology and microscopic evaluation of gross necropsy specimens revealed a primary large cell lymphoma of the central nervous system. In addition there was massive leptomenigeal lymphomatosis involving the cortex, brainstem, and cerebellum. No solitary intracranial mass lesion was found.

Ultrasonic features of two cases of spinal cord hemangioblastoma

Two patients with proven intramedullary spinal cord hemangioblastomas were examined with intraoperative ultrasound. The ultrasonic features of a hyperechoic intramedullary mass accompanied by nearby cysts and, in one case, by a syrinx correspond with well-known pathological and computed tomographic descriptions of these tumors. Ultrasonic guidance enabled the surgeon to identify the exact location of the tumors and to proceed with the surgery, limiting the dissection to the area detected. The ultrasound also revealed cysts associated with the tumors, thus providing valuable information to guide the progress of surgery.

Syrinx of the conus medullaris and filum terminale in association with multiple hemangioblastomas

A patient with multiple hemangioblastomas and syrinxes of the cerebellum and spinal cord is presented. An additional mass imaged at the L-3 vertebral level was identified by percutaneous syringography as a bilobular syrinx extending from the conus medullaris into the filum terminale. At surgery the syrinx was opened into the caudal cerebrospinal fluid space and the several hemangioblastomas excised. These spinal tumors all appeared to arise in juxtaposition to the posterolateral sulcus and dorsal sensory roots.