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Vargas-Urbina J, Crisanto-Silva JA, Vásquez-Perez C, Davila-Adrianzén A, Alcas-Seminario D, Lines-Aguilar W, Mamani-Choquepata R, Panta-Rojas G. Multimodal management of giant solid hemangioblastomas in two patients with preoperative embolization. Surg Neurol Int 2024; 15:144. [PMID: 38742001 PMCID: PMC11090543 DOI: 10.25259/sni_28_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/04/2024] [Indexed: 05/16/2024] Open
Abstract
Background Hemangioblastomas are benign vascular neoplasms, World Health Organization grade I, with the most frequent location in the cerebellum. Complete microsurgical resection can be a challenge due to excessive bleeding, which is why preoperative embolization takes importance. Case Description Two clinical cases are presented, a 25-year-old woman and a 75-year-old man, who presented with intracranial hypertension symptoms due to obstructive hydrocephalus; a ventriculoperitoneal shunt was placed in both cases; in addition, they presented with cerebellar signs. Both underwent embolization with ethylene vinyl alcohol copolymer, with blood flow reduction. After that, they underwent microsurgical resection within the 1st-week post embolization, obtaining, in both cases, gross total resection without hemodynamic complications, with clinical improvement and good surgical outcome. It is worth mentioning that surgical management is the gold standard that allows a suitable surgical approach, like in our patients, for which a lateral suboccipital craniotomy was performed. Conclusion Solid hemangioblastomas are less frequent than their cystic counterparts. The treatment is the surgical resection, which is a challenge and always has to be considered as an arteriovenous malformation in the surgical planning, including preoperative embolization to reduce perioperative morbidity and mortality and get good outcomes.
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Affiliation(s)
- John Vargas-Urbina
- Department of Neurosurgery, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
| | | | - Carlos Vásquez-Perez
- Department of Neurosurgery, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
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Garrido E, Ngoc HL, Guyotat J, Pelissou-Guyotat I, Jacquesson T, Delabar V, Manet R, Gallet C, Fenouil T, Streichenberger N, Vasiljevic A, Meyronet D, Jouanneau E, Ducray F, Dumot C, Picart T. Predictors of Progression in a Series of 81 Adult Patients Surgically Managed for an Intracranial Hemangioblastoma: Implications for the Postoperative Follow-Up. Cancers (Basel) 2024; 16:1261. [PMID: 38610939 PMCID: PMC11010926 DOI: 10.3390/cancers16071261] [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: 02/26/2024] [Revised: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
The aim was to identify predictors of progression in a series of patients managed for an intracranial hemangioblastoma, in order to guide the postoperative follow-up modalities. The characteristics of 81 patients managed for an intracranial hemangioblastoma between January 2000 and October 2022 were retrospectively analyzed. The mean age at diagnosis was of 48 ± 16 years. Eleven (14%) patients had von Hippel-Lindau disease. The most frequent tumor location was the cerebellar hemispheres (n = 51, 65%) and 11 (14%) patients had multicentric hemangioblastomas. A gross total resection was achieved in 75 (93%) patients. Eighteen (22%) patients had a local progression, with a median progression-free survival of 56 months 95% CI [1;240]. Eleven (14%) patients had a distant progression (new hemangioblastoma and/or growth of an already known hemangioblastoma). Local progression was more frequent in younger patients (39 ± 14 years vs. 51 ± 16 years; p = 0.005), and those with von Hippel-Lindau disease (n = 8, 44% vs. n = 3, 5%, p < 0.0001), multiple cerebral locations (n = 3, 17% vs. n = 2, 3%, p = 0.02), and partial tumoral resection (n = 4, 18% vs. n = 1, 2%, p = 0.0006). Therefore, it is advisable to propose a postoperative follow-up for at least 10 years, and longer if at least one predictor of progression is present.
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Affiliation(s)
- Elisabeth Garrido
- Department of Neurosurgery, Rouen University Hospital, 1 Rue de Germont, 76000 Rouen, France;
| | - Huy Le Ngoc
- Department of Neurosurgery, Hospital Bach Mai, 78 Giai Phong, Phuong Mai, Dong Da, Ha Noi 116305, Vietnam;
| | - Jacques Guyotat
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France; (J.G.); (I.P.-G.); (T.J.); (V.D.); (R.M.); (C.G.); (E.J.); (C.D.)
| | - Isabelle Pelissou-Guyotat
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France; (J.G.); (I.P.-G.); (T.J.); (V.D.); (R.M.); (C.G.); (E.J.); (C.D.)
| | - Timothée Jacquesson
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France; (J.G.); (I.P.-G.); (T.J.); (V.D.); (R.M.); (C.G.); (E.J.); (C.D.)
- Faculty of Medicine Lyon Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69003 Lyon, France; (T.F.); (N.S.); (A.V.); (D.M.); (F.D.)
| | - Violaine Delabar
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France; (J.G.); (I.P.-G.); (T.J.); (V.D.); (R.M.); (C.G.); (E.J.); (C.D.)
| | - Romain Manet
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France; (J.G.); (I.P.-G.); (T.J.); (V.D.); (R.M.); (C.G.); (E.J.); (C.D.)
| | - Clémentine Gallet
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France; (J.G.); (I.P.-G.); (T.J.); (V.D.); (R.M.); (C.G.); (E.J.); (C.D.)
| | - Tanguy Fenouil
- Faculty of Medicine Lyon Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69003 Lyon, France; (T.F.); (N.S.); (A.V.); (D.M.); (F.D.)
- Cancer Research Centre of Lyon (CRCL) INSERM 1052, CNRS 5286, 28 Rue Laennec, 69008 Lyon, France
- Department of Neuropathology, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
| | - Nathalie Streichenberger
- Faculty of Medicine Lyon Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69003 Lyon, France; (T.F.); (N.S.); (A.V.); (D.M.); (F.D.)
- Department of Neuropathology, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
- CNRS UMR 5310—INSERM U1217, Institut NeuroMyogène, 8 Avenue Rockefeller, 69008 Lyon, France
| | - Alexandre Vasiljevic
- Faculty of Medicine Lyon Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69003 Lyon, France; (T.F.); (N.S.); (A.V.); (D.M.); (F.D.)
- Cancer Research Centre of Lyon (CRCL) INSERM 1052, CNRS 5286, 28 Rue Laennec, 69008 Lyon, France
- Department of Neuropathology, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
| | - David Meyronet
- Faculty of Medicine Lyon Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69003 Lyon, France; (T.F.); (N.S.); (A.V.); (D.M.); (F.D.)
- Cancer Research Centre of Lyon (CRCL) INSERM 1052, CNRS 5286, 28 Rue Laennec, 69008 Lyon, France
- Department of Neuropathology, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
| | - Emmanuel Jouanneau
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France; (J.G.); (I.P.-G.); (T.J.); (V.D.); (R.M.); (C.G.); (E.J.); (C.D.)
- Faculty of Medicine Lyon Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69003 Lyon, France; (T.F.); (N.S.); (A.V.); (D.M.); (F.D.)
- Cancer Research Centre of Lyon (CRCL) INSERM 1052, CNRS 5286, 28 Rue Laennec, 69008 Lyon, France
| | - François Ducray
- Faculty of Medicine Lyon Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69003 Lyon, France; (T.F.); (N.S.); (A.V.); (D.M.); (F.D.)
- Cancer Research Centre of Lyon (CRCL) INSERM 1052, CNRS 5286, 28 Rue Laennec, 69008 Lyon, France
- Department of Neuro-Oncology, Hôpital Neurologique Pierre Wertheimer, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
| | - Chloe Dumot
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France; (J.G.); (I.P.-G.); (T.J.); (V.D.); (R.M.); (C.G.); (E.J.); (C.D.)
- Faculty of Medicine Lyon Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69003 Lyon, France; (T.F.); (N.S.); (A.V.); (D.M.); (F.D.)
- CarMeN Laboratoire, INSERM, INRAER, Université Claude Bernard Lyon 1, 59 Boulevard Pinel, 69500 Bron, France
| | - Thiebaud Picart
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France; (J.G.); (I.P.-G.); (T.J.); (V.D.); (R.M.); (C.G.); (E.J.); (C.D.)
- Faculty of Medicine Lyon Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69003 Lyon, France; (T.F.); (N.S.); (A.V.); (D.M.); (F.D.)
- Cancer Research Centre of Lyon (CRCL) INSERM 1052, CNRS 5286, 28 Rue Laennec, 69008 Lyon, France
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Xue J, Mo C. A case report of cerebellar hemangioblastoma simulated brain metastasis shown by magnetic resonance imaging. Medicine (Baltimore) 2024; 103:e37162. [PMID: 38335432 PMCID: PMC10860963 DOI: 10.1097/md.0000000000037162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/15/2024] [Indexed: 02/12/2024] Open
Abstract
RATIONALE Hemangioblastomas occur both sporadically and as an important component of von Hippel-Lindau (VHL) disease. The typical MRI features of hemangioblastoma are cysts with enhanced cystic wall nodules in the cerebellum or lesions with uniform enhancement on the surface or inside the spinal cord. If there is edema around hemangioblastoma, it is easy to be misdiagnosed as brain metastasis on MRI. PATIENT CONCERNS A 41-year-old male patient was found to have a lump in the pancreas during a health examination 3 months ago. Subsequently, the patient underwent surgical treatment. The postoperative pathology suggests that the pancreatic lesion is a neuroendocrine tumor. The patient subsequently came to our hospital for consultation on further treatment plans. Abnormal signals were found in the right cerebellum during pituitary magnetic resonance imaging (MRI) before the development of a treatment plan for neuroendocrine tumors. Subsequently, the patient underwent cerebellar mass resection surgery. The pathological result after the surgery was hemangioblastoma. DIAGNOSIS The patient underwent surgery to remove the tumor and was diagnosed with hemangioblastoma by pathological examination. Subsequently, the patient's genetic testing results confirmed the diagnosis of VHL syndrome. INTERVENTIONS The patient underwent cerebellar mass resection surgery. OUTCOMES The patient recovered after surgical resection. LESSONS In this report, we emphasize the atypical MRI manifestations of hemangioblastoma. For patients with VHL syndrome-related hemangioblastoma, genetic testing is necessary for the patient and their family members.
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Affiliation(s)
- Jiaxing Xue
- Department of Neurosurgery, People’s Hospital of Dingzhou, Dingzhou, China
| | - Chenlong Mo
- Department of Neurosurgery, People’s Hospital of Dingzhou, Dingzhou, China
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4
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Sheng Y, Zhao B, Cheng H, Yu Y, Wang W, Yang Y, Ding Y, Qiu L, Qin Z, Yao Z, Zhang X, Ren Y. A Convolutional Neural Network Model for Distinguishing Hemangioblastomas From Other Cerebellar-and-Brainstem Tumors Using Contrast-Enhanced MRI. J Magn Reson Imaging 2024. [PMID: 38206839 DOI: 10.1002/jmri.29230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Hemangioblastoma (HB) is a highly vascularized tumor most commonly occurring in the posterior cranial fossa, requiring accurate preoperative diagnosis to avoid accidental intraoperative hemorrhage and even death. PURPOSE To accurately distinguish HBs from other cerebellar-and-brainstem tumors using a convolutional neural network model based on a contrast-enhanced brain MRI dataset. STUDY TYPE Retrospective. POPULATION Four hundred five patients (182 = HBs; 223 = other cerebellar-and brainstem tumors): 305 cases for model training, and 100 for evaluation. FIELD STRENGTH/SEQUENCE 3 T/contrast-enhanced T1-weighted imaging (T1WI + C). ASSESSMENT A CNN-based 2D classification network was trained by using sliced data along the z-axis. To improve the performance of the network, we introduced demographic information, various data-augmentation methods and an auxiliary task to segment tumor region. Then, this method was compared with the evaluations performed by experienced and intermediate-level neuroradiologists, and the heatmap of deep feature, which indicates the contribution of each pixel to model prediction, was visualized by Grad-CAM for analyzing the misclassified cases. STATISTICAL TESTS The Pearson chi-square test and an independent t-test were used to test for distribution difference in age and sex. And the independent t-test was exploited to evaluate the performance between experts and our proposed method. P value <0.05 was considered significant. RESULTS The trained network showed a higher accuracy for identifying HBs (accuracy = 0.902 ± 0.031, F1 = 0.891 ± 0.035, AUC = 0.926 ± 0.040) than experienced (accuracy = 0.887 ± 0.013, F1 = 0.868 ± 0.011, AUC = 0.881 ± 0.008) and intermediate-level (accuracy = 0.827 ± 0.037, F1 = 0.768 ± 0.068, AUC = 0.810 ± 0.047) neuroradiologists. The recall values were 0.910 ± 0.050, 0.659 ± 0.084, and 0.828 ± 0.019 for the trained network, intermediate and experienced neuroradiologists, respectively. Additional ablation experiments verified the utility of the introduced demographic information, data augmentation, and the auxiliary-segmentation task. DATA CONCLUSION Our proposed method can successfully distinguish HBs from other cerebellar-and-brainstem tumors and showed diagnostic efficiency comparable to that of experienced neuroradiologists. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Yaru Sheng
- Radiology Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Botao Zhao
- Research Center for Augmented Intelligence, Zhejiang Lab, Hangzhou, China
| | - Haixia Cheng
- Neuropathology Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Yang Yu
- Radiology Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Weiwei Wang
- Radiology Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Yang Yang
- Radiology Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Yueyue Ding
- Department of Ultrasonography, Jing'an District Centre Hospital of Shanghai, Shanghai, China
| | - Longhua Qiu
- Radiology Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Zhiyong Qin
- Neurosurgery Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Zhenwei Yao
- Radiology Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoyong Zhang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Yan Ren
- Radiology Department of Huashan Hospital, Fudan University, Shanghai, China
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5
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Pons-Escoda A, Garcia-Ruiz A, Garcia-Hidalgo C, Gil-Solsona R, Naval-Baudin P, Martin-Noguerol T, Fernandez-Coello A, Flores-Casaperalta S, Fernandez-Viñas M, Gago-Ferrero P, Oleaga L, Perez-Lopez R, Majos C. MR dynamic-susceptibility-contrast perfusion metrics in the presurgical discrimination of adult solitary intra-axial cerebellar tumors. Eur Radiol 2023; 33:9120-9129. [PMID: 37439938 DOI: 10.1007/s00330-023-09892-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/16/2023] [Accepted: 05/30/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVES Adult solitary intra-axial cerebellar tumors are uncommon. Their presurgical differentiation based on neuroimaging is crucial, since management differs substantially. Comprehensive full assessment of MR dynamic-susceptibility-contrast perfusion-weighted imaging (DSC-PWI) may reveal key differences between entities. This study aims to provide new insights on perfusion patterns of these tumors and to explore the potential of DSC-PWI in their presurgical discrimination. METHODS Adult patients with a solitary cerebellar tumor on presurgical MR and confirmed histological diagnosis of metastasis, medulloblastoma, hemangioblastoma, or pilocytic astrocytoma were retrospectively retrieved (2008-2023). Volumetric segmentation of tumors and normal-appearing white matter (for normalization) was semi-automatically performed on CE-T1WI and coregistered with DSC-PWI. Mean normalized values per patient tumor-mask of relative cerebral blood volume (rCBV), percentage of signal recovery (PSR), peak height (PH), and normalized time-intensity curves (nTIC) were extracted. Statistical comparisons were done. Then, the dataset was split into training (75%) and test (25%) cohorts and a classifier was created considering nTIC, rCBV, PSR, and PH in the model. RESULTS Sixty-eight patients (31 metastases, 13 medulloblastomas, 13 hemangioblastomas, and 11 pilocytic astrocytomas) were included. Relevant differences between tumor types' nTICs were demonstrated. Hemangioblastoma showed the highest rCBV and PH, pilocytic astrocytoma the highest PSR. All parameters showed significant differences on the Kruskal-Wallis tests (p < 0.001). The classifier yielded an accuracy of 98% (47/48) in the training and 85% (17/20) in the test sets. CONCLUSIONS Intra-axial cerebellar tumors in adults have singular and significantly different DSC-PWI signatures. The combination of perfusion metrics through data-analysis rendered excellent accuracies in discriminating these entities. CLINICAL RELEVANCE STATEMENT In this study, the authors constructed a classifier for the non-invasive imaging presurgical diagnosis of adult intra-axial cerebellar tumors. The resultant tool can be a support for decision-making in the clinical practice and enables optimal personalized patient management. KEY POINTS • Adult intra-axial cerebellar tumors exhibit specific, singular, and statistically significant different MR dynamic-susceptibility-contrast perfusion-weighted imaging (DSC-PWI) signatures. • Data-analysis, applied to MR DSC-PWI, could provide added value in the presurgical diagnosis of solitary cerebellar metastasis, medulloblastoma, hemangioblastoma, and pilocytic astrocytoma. • A classifier based on DSC-PWI metrics yields excellent accuracy rates and could be used as a support tool for radiologic diagnosis with clinician-friendly displays.
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Affiliation(s)
- Albert Pons-Escoda
- Radiology Department, Hospital Universitari de Bellvitge, Feixa Llarga SN, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
- Neuro-Oncology Unit, Institut d'Investigació Biomedica de Bellvitge, IDIBELL, Barcelona, Spain.
| | | | | | - Ruben Gil-Solsona
- Institut de Diagnostic Ambiental i Estudis de l'Aigua (IDAEA) - CSIC, Barcelona, Spain
| | - Pablo Naval-Baudin
- Radiology Department, Hospital Universitari de Bellvitge, Feixa Llarga SN, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Alejandro Fernandez-Coello
- Neuro-Oncology Unit, Institut d'Investigació Biomedica de Bellvitge, IDIBELL, Barcelona, Spain
- Neurosurgery Department, Hospital Universitari de Bellvitge, Barcelona, Spain
- Biomedical Research Networking Centers of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Susanie Flores-Casaperalta
- Radiology Department, Hospital Universitari de Bellvitge, Feixa Llarga SN, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Montserrat Fernandez-Viñas
- Radiology Department, Hospital Universitari de Bellvitge, Feixa Llarga SN, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pablo Gago-Ferrero
- Institut de Diagnostic Ambiental i Estudis de l'Aigua (IDAEA) - CSIC, Barcelona, Spain
| | - Laura Oleaga
- Radiology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Carles Majos
- Radiology Department, Hospital Universitari de Bellvitge, Feixa Llarga SN, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
- Neuro-Oncology Unit, Institut d'Investigació Biomedica de Bellvitge, IDIBELL, Barcelona, Spain
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6
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Zhang H, Hui X. Predictors of blood loss in surgery for hemangioblastoma of posterior cranial fossa. Asian J Surg 2023; 46:4785-4786. [PMID: 37271646 DOI: 10.1016/j.asjsur.2023.05.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 06/06/2023] Open
Affiliation(s)
- Huan Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xuhui Hui
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
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Laviv Y, Saraf D, Oxman L, Zvi IB. Supratentorial hemangioblastoma: correlation between phenotype, gender and vascular territory affected. Neurosurg Rev 2023; 46:281. [PMID: 37875641 DOI: 10.1007/s10143-023-02194-y] [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: 07/22/2023] [Revised: 09/17/2023] [Accepted: 10/19/2023] [Indexed: 10/26/2023]
Abstract
Supratentorial hemangioblastomas are rare, vascular lesions. The presence of peri-tumoral cysts and edema has meaningful clinical, diagnostic and therapeutic implications. Nevertheless, the pathogenesis of both cyst and edema formation is not fully understood. This study sought to determine if the radiologic phenotype of supratentorial hemangioblastoma is affected by the different cerebral arterial circulations. Review of the English-language literature from 1973 to 2023 yielded 53 cases of parenchymal supratentorial hemangioblastomas eligible for analysis. Patients were divided by the vascular territorial distribution of the lesions: anterior circulation (n = 36) or posterior circulation (n = 17), and the groups were compared for demographic, clinical, radiologic and molecular variables. Univariate analyses yielded a significant difference between the groups in five variables. Cystic changes and "classic" radiological phenotype were associated with hemangioblastomas of the posterior circulation (OR = 0.19, p = 0.045 and OR = 0.287, p = 0.048, respectively), while female gender, significant peritumoral edema and purely solid phenotype were associated with hemangioblastomas of the anterior circulation (OR = 3.384, p = 0.045 and OR = 5.25, p = 0.05 and OR = 14.0, p = 0.015; respectively). On multivariate analysis, solid phenotype and female gender remained significantly associated with the anterior circulation (OR = 36.04, p = 0.014 and OR = 4.45, p = 0.045). The incidence of von-Hippel Lindau disease was higher in the anterior-circulation group. Cystic tumors were present in all females in the posterior-circulation group compared to 43.4% in the anterior-circulation group (OR = 20.714, 95% CI 1.061 to 404.122; p = 0.045). Based on historical cases of supratentorial hemangioblastoma, this study shows that different tumor phenotypes are associated with the different cerebral circulations. Gender was also associated with differences in tumor distribution and radiologic phenotype. These novel data may improve our understanding of unique vascular diseases of the central nervous system.
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Affiliation(s)
- Yosef Laviv
- Department of Neurosurgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - David Saraf
- Department of Neurosurgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat Oxman
- Department of Neurosurgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Ben Zvi
- Department of Neurosurgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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8
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Hamzah A, Bamsallm M, Alshammari KA, Alghamdi AM, Fallatah MA, Babgi M, Lary A. A bibliometric analysis of the top 100 cited articles for hemangioblastoma of the central nervous system. Neurosurg Rev 2023; 46:168. [PMID: 37414966 DOI: 10.1007/s10143-023-02070-9] [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: 03/14/2023] [Revised: 05/20/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023]
Abstract
Hemangioblastoma is a rare benign tumor that can affect the central nervous system sporadically or in association with von Hippel-Lindau (VHL) syndrome. Despite the advances in the medical field, hemangioblastoma still has a significant morbidity and mortality burden. This review gathered and analyzed this entity's top one hundred cited articles. The Scopus database was screened using the following keywords ("Hemangioblastoma" OR "Haemangioblastoma" OR "Hemangioblastomata"). The results were sorted by citation count, highest to lowest. Articles discussing hemangioblastoma of the central nervous system were included. Two independent reviewers extracted the article-, author-, and Journal-based data. Articles were classified into four categories: clinical features/ natural history, treatment, histopathology, review, or radiology. The location, brain, spine, or both, and type, sporadic, VHL-associated, or both, were used to classify the articles. The search query resulted in 4023 articles, and the top 100 most cited articles were included. The number of citations totaled 8781, averaging 87.81 CC per article. The included papers were published in 41 different journals between 1952 and 2014 by more than 11 departments from 65 institutions and 16 countries. The number of citations ranged from 46 to 333. The peak publication activity was before the 2000s, contributing to 62% of all articles, and the most prolific decade was 1990-2000, with 37 publications. We conducted a comprehensive bibliometric analysis of data from the most influential publications on central nervous system hemangioblastoma. We identified publication dynamics and research gaps. More high-impact studies are warranted to enhance disease comprehension and management.
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Affiliation(s)
- Abdulaziz Hamzah
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
| | - Mouaz Bamsallm
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | | | - Abdulaziz M Alghamdi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Mahmoud Ali Fallatah
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Mohammed Babgi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Surgery, Division of Neurosurgery, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
- Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, Quebec, Canada
| | - Ahmed Lary
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Surgery, Division of Neurosurgery, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
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9
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Chen X, Li F, Xu G, Su J, Shi Q, Dai H. Cerebellar Metastasis Manifesting as a Cyst with Mural Nodule(s): Differentiating It From Hemangioblastoma on MRI. World Neurosurg 2023; 175:e994-e1004. [PMID: 37087031 DOI: 10.1016/j.wneu.2023.04.059] [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: 03/11/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND A cyst with mural nodule(s) (CMN) is a rare imaging finding of cerebellar metastasis (CMET). It is a great challenge to differentiate it from cerebellar hemangioblastoma (CHB). In the present study, we explore the differences in the magnetic resonance imaging (MRI) characteristics of the 2 tumors. METHODS Patients with pathologically confirmed CMET or CHB at our hospital from July 2009 to September 2021 were enrolled in the present study. All the patients underwent conventional head MRI (before and after contrast administration) before surgery and had ≥1 lesion in the cerebellum that presented as CMN on MRI. The clinical and MRI features were compared between the 2 groups. RESULTS A total of 33 patients (10 with CMET and 23 with CHB) met the study criteria. The CMET patients were significantly older than were the CHB patients (median age, 59.5 years vs. 37 years; P = 0.002). Compared with the CHB group, the CMET group showed significantly higher occurrence rates of multiple mural nodules (72.7% vs. 8.7%), lack of vascular flow voids (100% vs. 65.2%), isointense or hypointense mural nodules on fluid-attenuated inversion recovery imaging (100.0% vs. 22.7%), restricted diffusion of mural nodules (22.2% vs. 0.0%), mildly enhanced mural nodules (90.9% vs. 4.3%), and a ring-enhanced pattern of the cyst wall (100% vs. 8.7%; P < 0.05 for all). CONCLUSIONS When CMN is detected in the cerebellum on MRI, older age, multiple mural nodules, absence of vascular flow voids, isointense or hypointense mural nodule on fluid-attenuated inversion recovery sequence, restricted diffusion of the mural nodule, mildly enhanced mural nodules, and a ring-enhanced pattern of the cyst wall are the clinical and imaging features that strongly indicate the likelihood of metastasis, rather than CHB.
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Affiliation(s)
- Xiaoxi Chen
- Department of Radiology, Medical Imaging Center of Guizhou Province, Affiliated Hospital of Zunyi Medical University, Zunyi, China.
| | - Fangling Li
- Department of Radiology, Medical Imaging Center of Guizhou Province, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Gaoqiang Xu
- Department of Radiology, Medical Imaging Center of Guizhou Province, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Jun Su
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Qingyang Shi
- Department of Radiology, Medical Imaging Center of Guizhou Province, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hui Dai
- Department of Radiology, Medical Imaging Center of Guizhou Province, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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10
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Taher MM, Bantan NA, Alwalily MH, Saeed M, Taher NM, Bouzidi M, Jastania RA, Balkhoyour KB. Supratentorial Sporadic Hemangioblastoma: A Case Report With Mutation Profiling Using Next-Generation DNA Sequencing. Cureus 2023; 15:e39818. [PMID: 37273678 PMCID: PMC10233511 DOI: 10.7759/cureus.39818] [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] [Accepted: 05/31/2023] [Indexed: 06/06/2023] Open
Abstract
The present study aimed to determine genomic changes in sporadic intracranial hemangioblastoma (HBL), and the mutation patterns were analyzed using next-generation DNA sequencing (NGS). In this NGS analysis of the HBL tumor, 67 variants of 41 genes were identified. Of these, 64 were single-nucleotide variants (SNVs), two were exonic insertions and deletions (INDEL), and one was an intronic INDEL. In total, 15 were missense exonic variants, including an insertion variant in the NRAS gene, c.1_2insA, and a deletion variant, c.745delT, in the HNF1A gene, both of these mutations produced a termination codon. Other exonic missense variants found in the tumor were CTNNB1, FGFR3, KDR, SMO, HRAS, RAI1, and a TP53 variant (c.430C>G). Moreover, the results of the present study revealed a novel variant, c.430C>G, in TP53 and two missense variants of SND1 (c.1810G>C and c.1814G>C), which were also novel. ALK (rs760315884) and FGFR2 (rs1042522) missense variants were reported previously. Notably, a total of 10 previously reported single-nucleotide polymorphisms (SNPs) were found in this tumor in genes including MLH1 (rs769364808), FGFR3 (rs769364808), two variants (rs1873778 and rs2228230) in PDGFRA, KIT (rs55986963), APC (rs41115), and RET (rs1800861). The results of this study revealed a synonymous mutation (SNP) in c.1104 G>T; p. (Ser368Ser) in the MLH1 gene. In this amino acid (AA) codon, two other variants are also known to cause missense substitutions, c.1103C>G; p. (Ser368Trp); COSM6986674) and c.1103C>T; p.(Ser368Leu; COSM3915870), were found in hematopoietic and urinary tract tissue, respectively. However, three SNPs found in genes such as ALK, KDR, and ABL1 in the HBL tumor in this study were not reported in UCSC, COSMIC, and ClinVar databases. Additionally, 19 intronic variants were identified in this tumor. One intronic SNV was present in each of the following genes: EGFR, ERBB4, KDR, SMO, CDKN2B, PTEN, PTPN11, RB1, AKT1, and ERBB2. In PIK3CA and FBXL18 genes, two intronic variants were present, and in the SND1 gene, three intronic variants were detected in the HBL tumor presented in this study. Notably, only one of these was reported in the catalog of somatic mutations in cancer. Only one 3'-untranslated region (UTR) insertion variant in the NRAS gene (c.*2010T>AT) was detected in the tumor of the present study, and this was a splice site acceptor. A TP53 intronic mutation (c.782+1G>T) was the only pathogenic splice_donor_variant found in this HBL tumor. The frequency of variants and Phred scores were markedly high, and the p-values were significant for all of the aforementioned mutations. In summary, a total of 15 missense, 10 synonymous, and 19 intronic variants were identified in the HBL tumor. Results of the present study detected one novel insertion in NRAS and one novel deletion in HNF1A genes, a novel missense variant in the TP53 gene, and two novel missense variants of SND1. Hotspot mutations in other cancer driver genes, such as PTEN, ATM, SMAD4, SMARCB1, STK11, NPM1, CDKN2A, and EGFR, which are frequently affected in gliomas, were not found in the tumor of the present study. Future studies should aim to validate oncogenic mutations that may act as novel targets for the treatment of these tumors.
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Affiliation(s)
- Mohiuddin M Taher
- Science and Technology Unit, Deanship of Scientific Research, Umm Al-Qura University, Makkah, SAU
- Department of Medical Genetics, Umm Al-Qura University College of Medicine, Makkah, SAU
| | - Najwa A Bantan
- Department of Radiology, Al-Noor Specialty Hospital, Makkah, SAU
| | | | - Muhammad Saeed
- Department of Radiology, Al-Noor Specialty Hospital, Makkah, SAU
| | - Nuha M Taher
- Department of Medical Genetics, Umm Al-Qura University College of Medicine, Makkah, SAU
| | - Meriem Bouzidi
- Department of Laboratory Medicine, Division of Histopathology, Al-Noor Specialty Hospital, Makkah, SAU
| | - Raid A Jastania
- Department of Pathology, Umm Al-Qura University College of Medicine, Makkah, SAU
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11
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Jankovic D, Vuong K, Splavski B, Rotim K, Arnautovic KI. Supratentorial Hemangioblastoma in Adults: A Systematic Review and Comparison of Infratentorial and Spinal Cord Locations. World Neurosurg 2023; 173:48-62. [PMID: 36822402 DOI: 10.1016/j.wneu.2023.02.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Supratentorial hemangioblastomas are benign and highly vascularized neoplasms that appear most often in the spine and posterior cranial fossa. They can also be located in the supratentorial compartment of the brain. We conducted a systematic review of the literature to better understand the clinical insights of supratentorial hemangioblastoma in adults. METHODS Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the authors reviewed the English-language literature in the PubMed/MEDLINE database on supratentorial hemangioblastoma in adults, published in the past 40 years. We analyzed the differences between sporadic hemangioblastomas and hemangioblastomas associated with von Hippel-Lindau disease. In addition, we compared the characteristics of supratentorial hemangioblastomas with infratentorial and spinal cord locations. RESULTS We reviewed 92 articles, describing 157 supratentorial hemangioblastomas in a total cohort of 148 adult patients. Most articles reporting supratentorial hemangioblastomas were published in the United States. Supratentorial hemangioblastomas occur more frequently in women than men. The median age at the time of diagnosis was 44.48 years. The sellar/parasellar region was the most commonly tumor location, while the most common morphological type was the solid type. Almost 80% of hemangioblastomas were completely resected; the outcome was favorable in more than 3 fourth of patients. CONCLUSIONS Given their rarity, the literature on supratentorial hemangioblastomas is limited and based mostly on case reports. Complete surgical resection is the first choice of treatment and is associated with a good treatment outcome.
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Affiliation(s)
- Dragan Jankovic
- Department of Neurosurgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Mainz, Germany; Faculty of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia
| | - Kyna Vuong
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Bruno Splavski
- Faculty of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia; University of Applied Health Sciences, Zagreb, Croatia
| | - Kresimir Rotim
- Faculty of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia; University of Applied Health Sciences, Zagreb, Croatia; Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; Faculty of Medicine, University of Zagreb, Zagreb, Croatia
| | - Kenan I Arnautovic
- Semmes Murphey Neurologic & Spine Institute, Memphis, Tennessee, USA; Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
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12
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Acharya A, Panigrahi S, Mahapatra AK, Deo RC, Senapati SB. Von-Hippel Lindau (VHL) syndrome with bilateral cerebellar hemangioblastomas and retinal angiomas: A rare presentation. Int J Surg Case Rep 2023; 106:108188. [PMID: 37080144 PMCID: PMC10140791 DOI: 10.1016/j.ijscr.2023.108188] [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: 02/13/2023] [Revised: 03/26/2023] [Accepted: 03/29/2023] [Indexed: 04/22/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Hemangioblastomas are benign vascular neoplasms which originate almost exclusively from central nervous system (CNS). They account for 2 % of all intracranial neoplasms, 7 %-12 % of posterior fossa tumours. 60-75 % cases of hemangioblastomas occur sporadically and rest 25 % to 40 % occur in genetically inherited in the autosomal dominant neoplasia syndrome known as Von Hippel-Lindau (VHL) disease with mutation occurring on chromosome 3p. CASE PRESENTATION We, hereby, report a case of one such rare case of a 30-year old male who presented to us with the complaint of holocranial headache for past 2 months associated with vomiting along with bilateral cerebellar signs and symptoms. MRI Brain revealed multiple cysts with enhancing mural nodules present on both cerebellar hemispheres. Due to recurrence and multi-focality of lesions, VHL syndrome was suspected. CLINICAL DISCUSSION VHL is a rare autosomal dominant disease. MRI is the gold standard test. It demonstrates specific appearances depending on the tumour anatomy. Hemangioblastoma of the CNS in VHL usually develop from childhood at an age of <10 years or early teen until the age of 30 years. The most common locations for hemangioblastomas in VHL are cerebellum and spinal cord as seen in our patient. CONCLUSION VHL being a lifelong disease with no cure till date, the patients should be frequently screened for lesions at various potential sites in his/her lifetime so as to provide required intervention at the earliest. Hence, a genetic screening for VHL (VHL tumour suppressor gene), should be performed in cases of hemangioblastoma.
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Affiliation(s)
- Abhijit Acharya
- Dept. of Neurosurgery, SOA IMS & SUM Hospital, Bhubaneswar, Odisha, India.
| | - Souvagya Panigrahi
- Dept. of Neurosurgery, SOA IMS & SUM Hospital, Bhubaneswar, Odisha, India
| | - A K Mahapatra
- Dept. of Neurosurgery, SOA IMS & SUM Hospital, Bhubaneswar, Odisha, India
| | - Rama Chandra Deo
- Dept. of Neurosurgery, SOA IMS & SUM Hospital, Bhubaneswar, Odisha, India
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13
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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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14
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Vetrano IG, Gioppo A, Faragò G, Pinzi V, Pollo B, Broggi M, Schiariti M, Ferroli P, Acerbi F. Hemangioblastomas and Other Vascular Origating Tumors of Brain or Spinal Cord. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:377-403. [PMID: 37452946 DOI: 10.1007/978-3-031-23705-8_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Hemangioblastomas (HBs) are highly vascularized, slow-growing, rare benign tumors (WHO grade I). They account for about 2% of intracranial neoplasms; however, they are the most common primary cerebellar tumors in adults. Another frequent seat is the spinal cord (2-10% of primary spinal cord tumors). HBs are constituted by stromal and capillary vascular cells; macroscopically, HBs appear as nodular tumors, with or without cystic components. Although most of the HBs are sporadic (57-75%), they represent a particular component of von Hippel-Lindau disease (VHL), an autosomal dominant syndrome with high penetrance, due to a germline pathogenic mutation in the VHL gene, which is a tumor suppressor with chromosomal location on the short arm of chromosome three. VHL disease determines a variety of malignant and benign tumors, most frequently HBs, renal cell carcinomas, pheochromocytomas/paragangliomas, pancreatic neuroendocrine tumors, and endolymphatic sac tumors. Up to 20% of cases are due to de novo pathogenic variants without a family history. Many epidemiologic details of these tumors, especially the sporadic forms, are not well known. The median age of patients with sporadic HBS is about 40 years. More than two-third of VHL patients develop one or more central nervous system HBs during their lifetime; in case of VHL, patients at first diagnosis are usually younger than the patients with sporadic tumors. The most common presenting signs and symptoms are related to increased intracranial pressure, cerebellar signs, or spinal cord alterations in case of spinal involvement. Magnetic resonance imaging is the gold standard for the diagnosis, assessment, and follow-up of HBs, both sporadic and syndrome-related; angiography is rarely performed because the diagnosis is easily obtained with magnetic resonance. However, the diagnosis of an asymptomatic lesion does not automatically result in therapeutic actions, as the risks of treatment and the onset of possible neurological deficit need to be balanced, considering that HBs may remain asymptomatic and have a static or slow-growing behavior. In such cases, regular follow-up can represent a valid therapeutic option until the patients remain asymptomatic. There are no actual pharmacological therapies that are demonstrated to be effective for HBs. Surgery represents the primary therapeutic approach for these tumors. Observation or radiotherapy also plays a role in the long-term management of patients harboring HBs, especially in VHL; in few selected cases, endovascular treatment has been suggested before surgical removal. This chapter presents a systematic overview of epidemiology, clinical appearance, histopathological and neuroradiological characteristics of central nervous system HBs. Moreover, the genetic and molecular biology of sporadic and VHL HBS deserves special attention. Furthermore, we will describe all the available therapeutic options, along with the follow-up management. Finally, we will briefly report other vascular originating tumors as hemangioendotheliomas, hemangiomas, or angiosarcomas.
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Affiliation(s)
- Ignazio G Vetrano
- Neurovascular Surgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Gioppo
- Interventional Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giuseppe Faragò
- Interventional Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Valentina Pinzi
- Radiotherapy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Bianca Pollo
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Morgan Broggi
- Neurovascular Surgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco Schiariti
- Neurovascular Surgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paolo Ferroli
- Neurovascular Surgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Acerbi
- Neurovascular Surgery Unit and Experimental Microsurgical Laboratory, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via G. Celoria 11, 20133, Milan, Italy.
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15
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Mazzapicchi E, Restelli F, Falco J, Broggi M, Gatti L, Alongi P, Valentini L, Ferroli P, Vetrano IG, DiMeco F, Acerbi F. Sporadic and von Hippel-Lindau Related Hemangioblastomas of Brain and Spinal Cord: Multimodal Imaging for Intraoperative Strategy. Cancers (Basel) 2022; 14:cancers14225492. [PMID: 36428588 PMCID: PMC9688688 DOI: 10.3390/cancers14225492] [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: 09/17/2022] [Revised: 10/31/2022] [Accepted: 11/07/2022] [Indexed: 11/12/2022] Open
Abstract
Hemangioblastomas (HBs) are rare, benign tumors often related to von Hippel-Lindau disease. They represent the most frequent primary cerebellar tumors in adults. Neurosurgical procedures aim to obtain a gross-total resection of tumor nodules, avoiding intra-postoperative hemorrhage. The introduction of new intraoperative imaging techniques has considerably changed surgical strategies in neuro-oncology. We present an overview of clinical and radiological data of a mono-institutional retrospective cohort, focusing on the role of intraoperative multimodal imaging in surgical strategy. From 2015 to 2021, we identified 64 (81%) cranial (42 cerebellar, 8 supratentorial, and 14 of the brainstem) HBs and 15 (19%) spinal (4 cervical and 11 dorsal) HBs in 79 patients. Intraoperatively, indocyanine green videoangiography with FLOW800 was used in 62 cases (52 cranial and 10 spinal), intraoperative ultrasound and contrast-enhanced ultrasounds in 22 cases (18 cranial and 4 spinal HBs), and fluorescein in 10 cases (in 6 cranial and 2 spinal cases used as SF-VA). Gross total resection was achieved in 100% of the cases (53 mural nodule removal and 26 complete resections of the solid tumor). No side effects were reported following the combination of these tools. Multimodal intraoperative techniques provide valuable and reliable information to identify the tumor and its vasculature, guiding a more precise and safer resection and reducing the risk of recurrence.
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Affiliation(s)
- Elio Mazzapicchi
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Francesco Restelli
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Jacopo Falco
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Morgan Broggi
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Laura Gatti
- Neurobiology Laboratory, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Pierpaolo Alongi
- Nuclear Medicine Unit, ARNAS Ospedali Civico, Di Cristina e Benfratelli, 90127 Palermo, Italy
| | - Laura Valentini
- Neurosurgical Unit 1, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Paolo Ferroli
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Ignazio G. Vetrano
- Neurosurgical Unit 1, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Department of Biomedical Sciences for Health, Università di Milano, 20122 Milan, Italy
- Correspondence:
| | - Francesco DiMeco
- Neurosurgical Unit 1, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Department of Oncology and Hemato-Oncology, Università di Milano, 20122 Milan, Italy
- Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, MD 21205, USA
| | - Francesco Acerbi
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Experimental Microsurgical Laboratory, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
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Roach J, Livermore L, Plaha P. Endoscope-Assisted Resection for Cystic Cerebellar Hemangioblastomas. World Neurosurg 2022; 167:e217-e221. [PMID: 35944859 DOI: 10.1016/j.wneu.2022.07.132] [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: 04/04/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Hemangioblastomas are benign, often cystic tumors occurring most commonly in the cerebellum. We describe resection of cystic cerebellar hemangioblastomas using an endoscope-assisted technique. METHODS We present a series of 9 cases and discuss the endoscopic technique for resection of cystic hemangioblastoma. Frameless neuronavigation was used in all cases. A small 1- to 1.5-cm corticotomy lined with Surgicel and patties allows access to the peritumoral cyst. Using bimanual microsurgical techniques and the 30-degree rigid endoscope to provide visualization, the mural nodule can be resected and the cyst cavity inspected. RESULTS Complete resection of the mural nodule was achieved in all cases. One patient had a postsurgery pseudomeningocele requiring ventriculoperitoneal shunt. Hospital length of stay was short for all the patients. CONCLUSIONS Endoscope-assisted resection is a safe and effective technique for surgical resection of cystic hemangioblastoma.
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Affiliation(s)
- Joy Roach
- Department of Neurosurgery, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, Oxfordshire, United Kingdom.
| | - Laurent Livermore
- Department of Neurosurgery, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, Oxfordshire, United Kingdom
| | - Puneet Plaha
- Department of Neurosurgery, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, Oxfordshire, United Kingdom
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17
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Tirado-Ornelas HA, Olivares-Peña JL, Olivares-Camacho JL, Santos-Franco JA, Ochoa-González MV. Intramedullary cervical spinal cord and cerebellar hemangioblastoma: A case report. Surg Neurol Int 2022; 13:294. [PMID: 35855144 PMCID: PMC9282796 DOI: 10.25259/sni_525_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/22/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Hemangioblastomas are benign tumors that develop in the central nervous system. They represent 1.5–2.5% of all intracranial tumors, and about 2–15% of all spinal cord tumors. They are highly associated with von Hippel–Lindau disease.
Case Description:
A 36-year-old female presented with a 4-year history of progressive right upper extremity distal weakness and cervical pain. The magnetic resonance imaging demonstrated a homogeneously, contrast enhancing intradural/intramedullary tumor at C6–C7 with perilesional edema and a syrinx accompanied by a cerebellar cyst with a mural nodule. Surgery included excision of the spinal lesion and decompression and excision of the cerebellar cyst and mural nodule (i.e., median suboccipital craniectomy and cervical C5–C7 laminectomy).
Conclusion:
Surgery is the gold standard treatment for symptomatic hemangioblastomas, and surgical approaches should minimize risk.
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Affiliation(s)
- Héctor Alonso Tirado-Ornelas
- Department of Neurosurgery, Specialties Hospital, La Raza National Medical Center, Mexican Social Security Institute, Mexico City, Mexico
| | - Jorge Luis Olivares-Peña
- Department of Neurosurgery, Specialties Hospital, La Raza National Medical Center, Mexican Social Security Institute, Mexico City, Mexico
| | | | - Jorge Arturo Santos-Franco
- Department of Neurosurgery, Specialties Hospital, La Raza National Medical Center, Mexican Social Security Institute, Mexico City, Mexico
| | - Maurilio Vicente Ochoa-González
- Department of Neurosurgery, Specialties Hospital, La Raza National Medical Center, Mexican Social Security Institute, Mexico City, Mexico
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Moscovici S, Candanedo C, Spektor S, Cohen JE, Kaye AH. Solid vs. cystic predominance in posterior fossa hemangioblastomas: implications for cerebrovascular risks and patient outcome. Acta Neurochir (Wien) 2022; 164:1357-1364. [PMID: 33811520 DOI: 10.1007/s00701-021-04828-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/23/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hemangioblastomas (HGBs) are highly vascular benign tumors, commonly located in the posterior fossa, and 80% of them are sporadic. Patients usually present with features of raised intracranial pressure and cerebellar symptoms. HGB can be classified as either mostly cystic or solids. Although the solid component is highly vascularized, aneurysm or hemorrhagic presentation is rarely described, having catastrophic results. METHODS We identified 32 consecutive patients with posterior fossa HBG who underwent surgery from 2008 through 2020 at our medical center. Tumors were classified as predominantly cystic or solid according to radiological features. Resection was defined as gross total (GTR) or subtotal (STR). RESULTS During the study period, 32 posterior fossa HGBs were resected. There were 26 cerebellar lesions and 4 medullar lesions, and in 2 patients, both structures were affected. Predominant cystic tumors were seen in 15 patients and solids in 17. Preoperative digital subtraction angiography (DSA) was performed in 8 patients with solid tumors, and 4 showed tumor-related aneurysms. Embolization of the tumors was performed in 6 patients, including the four tumor-related aneurysms. GTR was achieved in 29 tumors (91%), and subtotal resection in 3 (9%). Three patients had postoperative lower cranial nerve palsy. Functional status was stable in 5 patients (16%), improved in 24 (75%), and 3 patients (9%) deteriorated. One patient died 2 months after the surgery. Two tumors recurred and underwent a second surgery achieving GTR. The mean follow-up was 42.7 months (SD ± 51.0 months). CONCLUSIONS Predominant cystic HGB is usually easily treated as the surgery is straightforward. Those with a solid predominance present a more complex challenge sharing features similar to arteriovenous malformations. Given the important vascular association of solid predominance HGB with these added risk factors, the preoperative assessment should include DSA, as in arteriovenous malformations, and endovascular intervention should be considered before surgery.
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Affiliation(s)
- Samuel Moscovici
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, 91120, Jerusalem, Israel.
| | - Carlos Candanedo
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, 91120, Jerusalem, Israel
| | - Sergey Spektor
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, 91120, Jerusalem, Israel
| | - José E Cohen
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, 91120, Jerusalem, Israel
| | - Andrew H Kaye
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, 91120, Jerusalem, Israel
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Matsusue E, Inoue C, Tabuchi S, Yoshioka H, Nagao Y, Matsumoto K, Nakamura K, Fujii S. Advanced magnetic resonance imaging findings of cerebellar hemangioblastomas: A report of three cases and a literature review. Acta Radiol Open 2022; 11:20584601221077074. [PMID: 35273810 PMCID: PMC8902200 DOI: 10.1177/20584601221077074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/12/2022] [Indexed: 11/17/2022] Open
Abstract
On conventional magnetic resonance imaging (MRI), hemangioblastomas typically
appear as mural nodules with an adjacent surrounding cyst or a solid mass in the
cerebellum. However, hemangioblastomas sometimes cannot be reliably
distinguished using this imaging technique from other tumors, especially
pilocytic astrocytomas and metastatic tumors, because of their similar imaging
findings and locations. Herein, we report three cases of cerebellar
hemangioblastomas and review their findings on conventional and advanced MRI,
including diffusion-weighted imaging (DWI), dynamic susceptibility-weighted
contrast-enhanced perfusion-weighted imaging (DSC-PWI), and magnetic resonance
spectroscopy (MRS). Solid contrast-enhanced lesions of hemangioblastomas showed
increased apparent diffusion coefficient values on DWI, increased relative
cerebral blood volume ratio on DSC-PWI, and high lipid/lactate peak on MRS.
Therefore, advanced MRI techniques can be helpful in understanding the
pathological and metabolic changes of hemangioblastomas and may be useful for
their characterization.
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Affiliation(s)
- Eiji Matsusue
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Chie Inoue
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Sadaharu Tabuchi
- Department of Neurosurgery, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Hiroki Yoshioka
- Department of Neurosurgery, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Yuichiro Nagao
- Department of Neurosurgery, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Kensuke Matsumoto
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Kazuhiko Nakamura
- Department of Radiology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Shinya Fujii
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Tottori University, Tottori, Japan
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Freiburg Neuropathology Case Conference : An 89-year-old Patient with a History of Domestic Falls, Dysarthria and a slowly Progressive Cerebellar Mass Lesion. Clin Neuroradiol 2022; 32:313-319. [PMID: 35199211 PMCID: PMC8894187 DOI: 10.1007/s00062-022-01142-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 11/30/2022]
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Yin X, Duan H, Yi Z, Lu R, Li C, Li L. Clinical characteristics, surgical treatment, and risk factor analysis of postoperative functional outcome in patients with intracranial hemangioblastoma. World Neurosurg 2022; 161:e427-e435. [DOI: 10.1016/j.wneu.2022.02.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 02/04/2022] [Accepted: 02/04/2022] [Indexed: 10/19/2022]
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Li L, Xie HM, Richard SA, Lan Z. Hemangioblastoma masquerading as a ring enhancing lesion in the cerebellum: A case report. Medicine (Baltimore) 2022; 101:e28665. [PMID: 35060562 PMCID: PMC8772639 DOI: 10.1097/md.0000000000028665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/05/2022] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Hemangioblastomas (HGBMs) are very rare, and the cerebellum is usually the most common site of occurrence. HGBMs with ring-enhanced walls are often misdiagnosed as metastases, abscesses, glioblastomas, tuberculomas, and demyelinating diseases. Thus, we present a rare case of HGBM masquerading as a ring-enhancing lesion in the cerebellum. PATIENT CONCERNS We present a 33-year-old female who was admitted to our department because of headaches, unstable walking, and visual loss in both eyes. Cranial nerve examination revealed deficits in cranial nerve II. DIAGNOSIS Magnetic resonance imaging revealed 2 cystic lesions in the cerebellum, with irregular ring-enhanced cyst walls composed of smaller nodular parts. Immunohistochemical staining of resected specimens established HGBM. INTERVENTIONS The lesions were completely resected using a right retrosigmoid approach. OUTCOMES Two years of follow-up revealed no recurrence of her symptoms or tumor. She is currently well and performs her daily duties. LESSONS HGBMs with enhanced cysts are often misdiagnosed by radiology because of their ring-enhanced nature. Computed tomography angiography may be the best modality for differentiating cerebellar HGBM from other ring-enhancing lesions. Surgery is the gold standard of treatment for these lesions.
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Affiliation(s)
- Li Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Hui-Min Xie
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Seidu A. Richard
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Department of Medicine, Princefield University, Ghana, West Africa
| | - Zhigang Lan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
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Jeon C, Choi JW, Kong DS, Nam DH, Lee JI, Seol HJ. Treatment Strategy for Giant Solid Hemangioblastomas in the Posterior Fossa: A Retrospective Review of 13 Consecutive Cases. World Neurosurg 2021; 158:e214-e224. [PMID: 34728396 DOI: 10.1016/j.wneu.2021.10.169] [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: 08/07/2021] [Revised: 10/23/2021] [Accepted: 10/25/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To analyze radiologic characteristics, treatment strategy, and treatment outcomes of posterior fossa giant solid hemangioblastomas (GSHBs; ≥4 cm in maximum diameter). METHODS We performed a retrospective study of 13 consecutive patients (9 male and 4 female patients; mean age, 57.5 ± 13.3 years; range, 24-76 years) with GSHB who underwent surgical resection at a single institution between 2002 and 2018. The median follow-up was 33 months (range, 12-120 months). For each patient, neuroimaging findings, operative record, and treatment outcome were reviewed. RESULTS Seven tumors (53.8%) were located within cerebellar hemispheres, 4 (30.8%) in proximity to the brainstem, 1 (7.7%) within the cerebellar vermis, and 1 (7.7%) in the cerebellopontine angle. The mean maximum diameter was 4.8 ± 0.8 cm (range, 4.0-6.7 cm). Gross total resection was achieved in 11 patients (84.6%), and near-total resection in 2 patients (15.4%). Surgical complications occurred in 5 patients (38.5%); persistent neurologic deficits occurred in 2 patients (15.4%). Estimated progression-free survival after surgery was 92.3%, 80.8%, and 80.8% at 1, 5, and 10 years, respectively, whereas the estimated 1-year, 5-year, and 10-year overall survival was 100%, 90%, and 90%, respectively. CONCLUSIONS GSHBs are surgically challenging. The current study shows that favorable outcome can be achieved for GSHBs in the cerebellar hemispheres and vermis. For those involving the brainstem, planned near-total resection or subtotal resection in a piecemeal fashion can be attempted if en bloc resection is judged to be infeasible, and further intervention can be considered as needed.
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Affiliation(s)
- Chiman Jeon
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Won Choi
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Do-Hyun Nam
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung-Il Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ho Jun Seol
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Jankovic D, Hanissian A, Rotim K, Splavski B, Arnautovic KI. Novel Clinical Insights into Spinal Hemangioblastoma in Adults: A Systematic Review. World Neurosurg 2021; 158:1-10. [PMID: 34687932 DOI: 10.1016/j.wneu.2021.10.105] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Hemangioblastomas (HBs) are well-vascularized, benign central nervous system tumors and the third most common primary spinal cord tumor after astrocytoma/ependymoma, occurring sporadically or as a part of autosomal dominant von Hippel-Lindau disease, in which tumors are often multiple and prone to relapse. Spinal HBs are commonly located in the cervical cord and associated with a syrinx formation. Owing to location and growth trends, they may cause significant neurological deficit, impairing quality of life. We conducted a systematic review to understand better clinical insights into spinal HB in adults and compare spinal HB versus posterior cranial fossa HB. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for conducting systematic reviews, we reviewed the English-language literature on adult spinal HB in the MEDLINE/PubMed database over the last 40 years. RESULTS We reviewed 237 articles on adult spinal HB and analyzed national and continental distribution, clinical symptoms, tumor location and presence of syringomyelia, treatment strategies and postoperative complications, histology and immunochemistry, and treatment outcomes. We compared individual characteristics in sporadic and von Hippel-Lindau disease spinal HBs. Finally, we compared features of posterior cranial fossa and spinal HBs. CONCLUSIONS Spinal cord HBs most commonly have a dorsal intramedullary location. Total surgical tumor resection is the first treatment option; preoperative embolization may be performed to reduce intraoperative bleeding and surgical time. HBs located in the spine have decreased mortality and rate of infection, but increased rates of cardiopulmonary complications compared with HBs in the posterior cranial fossa.
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Affiliation(s)
- Dragan Jankovic
- Department of Neurosurgery, University Medical Centre of Johannes Gutenberg University of Mainz, Mainz, Germany
| | | | - Kresimir Rotim
- Department of Neurosurgery, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia; J.J. Strossmayer University of Osijek Faculty of Medicine, Osijek, Croatia; University of Applied Health Sciences, Zagreb, Croatia
| | - Bruno Splavski
- Department of Neurosurgery, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia; J.J. Strossmayer University of Osijek Faculty of Medicine, Osijek, Croatia; University of Applied Health Sciences, Zagreb, Croatia; J.J. Strossmayer University of Osijek Faculty of Dental Medicine and Health, Osijek, Croatia
| | - Kenan I Arnautovic
- Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA; Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
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Sirko A, Halkin M, Cherednychenko Y, Perepelytsia V. Staged surgical treatment of a hypervascular cerebellar hemangioblastoma and saccular superior cerebellar artery aneurysm using preoperative embolization with a low viscosity non-adhesive liquid embolic agent. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Lahkim M, Andour H, Laamrani FZ, Allaoui M, Saouab R, El Fenni J, En-Nouali H. Cerebellar hemangioblastoma: Case report with review of the literature. Radiol Case Rep 2021; 16:3109-3112. [PMID: 34429813 PMCID: PMC8367806 DOI: 10.1016/j.radcr.2021.07.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/08/2021] [Accepted: 07/10/2021] [Indexed: 12/12/2022] Open
Abstract
Originally recognized by Cushing and Bailey, hemangioblastoma is a developmental vascular neoplasm that is predominantly found in the posterior fossa. It is a highly vascularized tumor, with well-differentiated histologic features. Although rare, it remains the most common primary tumor of cerebellum in adults, along with metastases. MRI is the gold standard, allowing a precise characterization of the lesion's features, and its relationship with the surrounding structures. We report the case of a patient with a cerebellar symptomatology, in whom brain MRI raises the diagnosis of hemangioblastoma, which was then confirmed by histopathologic examination.
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Affiliation(s)
- Mohamed Lahkim
- Radiology Department, Mohammed V Military Hospital, Rabat, Morocco
| | - Hajar Andour
- Radiology Department, Mohammed V Military Hospital, Rabat, Morocco
| | | | - Mohamed Allaoui
- Histology Department, Mohammed V Military Hospital, Rabat, Morocco
| | - Rachida Saouab
- Radiology Department, Mohammed V Military Hospital, Rabat, Morocco
| | - Jamal El Fenni
- Radiology Department, Mohammed V Military Hospital, Rabat, Morocco
| | - Hassan En-Nouali
- Radiology Department, Mohammed V Military Hospital, Rabat, Morocco
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Singh PR, Sharma RK, Chaturvedi J, Nayak N, Sharma AK. Surgical Outcome of Large Solid Posterior Fossa Hemangioblastoma without Preoperative Embolization. J Neurol Surg A Cent Eur Neurosurg 2021; 83:224-230. [PMID: 34433222 DOI: 10.1055/s-0041-1728766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Large solid hemangioblastoma in the posterior fossa has an abundant blood supply as an arteriovenous malformation. The presence of adjacent vital neurovascular structures makes them vulnerable and difficult to operate. Complete surgical resection is always a challenge to the neurosurgeon. MATERIAL AND METHOD We share the surgical difficulties and outcome in this case series of large solid hemangioblastomas without preoperative embolization as an adjunct. This study included five patients (three men and two women, with a mean age of 42.2 years). Preoperative embolization was attempted in one patient but was unsuccessful. All the patients have headache (100%) and ataxia (100%) as an initial symptom. A ventriculoperitoneal shunt was inserted in one case before definite surgery due to obstructive hydrocephalus. The surgical outcome was measured using the Karnofsky Performance Status (KPS) score. RESULT The tumor was excised completely in all the cases. No intra- and postoperative morbidity occurred in four patients; one patient developed transient lower cranial nerve palsy. Mean blood loss was 235 mL, and no intraoperative blood transfusion was needed in any case. The mean follow-up period was 14.2 months. The mean KPS score at last follow-up was 80.One patient had a KPS score of 60. CONCLUSION Our treatment strategy is of circumferential dissection followed by en bloc excision, which is the optimal treatment of large solid hemangioblastoma. The use of adjuncts as color duplex sonography and indocyanine green video angiography may help complete tumor excision with a lesser risk of complication. Preoperative embolization may not be needed to resect large solid posterior fossa hemangioblastoma, including those at the cerebellopontine angle location.
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Affiliation(s)
| | | | | | - Nitish Nayak
- Department of Neurosurgery, AIIMS, Raipur, Chhattisgarh, India
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Merrill SA, Bendok BR. Commentary: Pineal Region Hemangioblastoma Resection Through Paramedian Supracerebellar Approach: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E36-E37. [PMID: 33956942 DOI: 10.1093/ons/opab127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sarah A Merrill
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, USA
| | - Bernard R Bendok
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA.,Department of Otolaryngology, Mayo Clinic, Phoenix, Arizona, USA.,Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA
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Watanabe T, Suematsu Y, Saito K, Takeishi G, Yamashita S, Ohta H, Yokogami K, Takeshima H. Selection of surgical approach for cerebellar hemangioblastomas based on venous drainage patterns. Neurosurg Rev 2021; 44:3567-3579. [PMID: 33877465 DOI: 10.1007/s10143-021-01544-y] [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: 12/04/2020] [Revised: 02/09/2021] [Accepted: 04/08/2021] [Indexed: 11/25/2022]
Abstract
Cerebellar hemangioblastomas remain surgically challenging because of the narrow, deep surgical corridors and tumor hypervascularity. Various surgical approaches are used according to the location, but optimal approaches have not been established. We propose a system of surgical approaches based on the venous drainage systems to facilitate surgical planning and achieve acceptable neurological outcomes. Cerebellar hemangioblastomas were divided into five types based on the main drainage systems: suboccipital hemangioblastomas draining to the transverse sinus (TS) or torcula, tentorial hemangioblastomas draining to the tentorial sinus or straight sinus, petrosal hemangioblastomas draining to the superior petrosal sinus (SPS), quadrigeminal hemangioblastomas draining to the galenic system, and tonsillar hemangioblastomas draining to the TS or torcula in conjunction with jugular bulb or SPS. Microsurgical approaches and patient outcome were retrospectively reviewed according to this classification. This study included 17 patients who underwent 21 operations for resection of 19 cerebellar hemangioblastomas, classified into 9 suboccipital, 4 tentorial, 2 petrosal, 2 quadrigeminal, and 2 tonsillar. Standard suboccipital craniotomies were utilized for suboccipital hemangioblastomas, the occipital transtentorial approach (OTA), and supracerebellar infratentorial approach for tentorial hemangioblastomas, the retrosigmoid approach for petrosal hemangioblastomas, OTA for quadrigeminal hemangioblastomas, and midline suboccipital approach for tonsillar hemangioblastomas. Gross total resection was achieved in all patients except one. Two patients with large hemangioblastomas (tonsillar and quadrigeminal) required second-stage operation which finally achieved gross total removal. No single approach had a significantly higher incidence of postoperative neurological deficits. Selection of the optimum surgical approach for cerebellar hemangioblastomas was successful based on the main drainage systems. Understanding of tumor growth and extension with respect to the venous drainage system is critical to select the appropriate surgical approach.
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Affiliation(s)
- Takashi Watanabe
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake-cho, Miyazaki, 889-1692, Japan.
| | - Yuuki Suematsu
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake-cho, Miyazaki, 889-1692, Japan
| | - Kiyotaka Saito
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake-cho, Miyazaki, 889-1692, Japan
| | - Go Takeishi
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake-cho, Miyazaki, 889-1692, Japan
| | - Shinji Yamashita
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake-cho, Miyazaki, 889-1692, Japan
| | - Hajime Ohta
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake-cho, Miyazaki, 889-1692, Japan
| | - Kiyotaka Yokogami
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake-cho, Miyazaki, 889-1692, Japan
| | - Hideo Takeshima
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake-cho, Miyazaki, 889-1692, Japan
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Central nervous system hemangioblastomas: An age-stratified analysis. Clin Neurol Neurosurg 2020; 199:106281. [PMID: 33091656 DOI: 10.1016/j.clineuro.2020.106281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/18/2020] [Accepted: 10/04/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hemangioblastomas (HBs) are rare and understudied. The impact of age on clinical features, optimal treatment, and postoperative outcome in HBs has not been systemically studied. MATERIALS AND METHODS We performed an institutional study in the West China Hospital, including patients diagnosed with hemangioblastomas between October 2011 and October 2016. Clinical data and surgical outcomes were compared among three different age groups (0-20, 21-59, and ≥ 60 years). We also studied surgical prognostic factors. RESULTS 187 patients (102 males and 85 females) were identified. HBs in spinal locations were more prevalent in children and adolescents, while the most common site in young and old-age adults was the cerebellum (P = 0.023). Risk of Von Hippel-Lindau syndrome (VHL) was negatively correlated with patient age (P = 0.003). 47.6 % of patients aged 0-20, 23 % of patients aged 21-59, and 6.45 % of patients aged ≥60 years were diagnosed with VHL. Older aged patients had a significantly lower risk of VHL and had a lower tumor recurrence rate. Surgical resection was an adequate and sufficient procedure in all age groups with a favorable surgical outcome (P = 0.823). Solid tumor, VHL disease, and localization in the brainstem were associated with poor outcome in patients with hemangioblastomas. CONCLUSIONS Our study showed that HBs in elderly patients were mostly included in the cerebellum and had a solid configuration and large size, while HBs in children were mainly localized in the spinal cord. VHL disease was more common in children and adolescents but rare in patients older than 60 years. The present study found no excess surgical mortality and risks for HBs in elderly patients or children than in younger adults.
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Xia H, Li J, Xia Y, Zhong D, Wu X, He D, Shi D, Li J, Sun X. Sporadic Solid/Cystic Hemangioblastomas in the Cerebellum: Retrospective Study of More Than Ten Years of Experience in a Single Center. World Neurosurg 2020; 144:e908-e915. [PMID: 32980566 DOI: 10.1016/j.wneu.2020.09.104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/18/2020] [Accepted: 09/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Solid/cystic hemangioblastomas are rare, and they lack a systematic description. We clarify the epidemiology, clinical features, imaging characteristics, and surgical outcomes of sporadic solid/cystic hemangioblastomas in the cerebellum. METHODS A total of 75 patients with sporadic hemangioblastomas from 2006 to 2018 were enrolled in this retrospective study and divided into solid (26/75), cystic (40/75), and solid/cystic (9/75) groups according to the imaging findings. All patients underwent microsurgical resection and had a definite 31 pathologic diagnosis. RESULTS The age at diagnosis in the solid/cystic group was the highest among the 3 groups (P < 0.05). The solid/cystic group showed the shortest symptom duration (P < 0.05), which was related to obvious peritumoral brain edema (P < 0.05). The combination of computed tomography angiography and magnetic resonance imaging helped with the differential diagnosis. The solid/cystic group showed the lowest rate of gross total resection (P < 0.05) as a result of the obscure brain-tumor interface, and the guidance of intraoperative ultrasonography helped with the microsurgical procedures to a certain extent. Patients in the solid/cystic group showed greater intraoperative blood loss (P < 0.05), a lower ratio of symptom improvement (P < 0.05), and a longer mean hospital stay (P < 0.05) than did patients in the cystic group. CONCLUSIONS Cerebellar sporadic solid/cystic hemangioblastomas are rare and usually affect elderly people. The combination of computed tomography angiography and magnetic resonance imaging may improve the preoperative diagnosis. Solid/cystic hemangioblastomas showed the lowest rate of gross total resection as a result of the obscure brain-tumor interface.
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Affiliation(s)
- Haijian Xia
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Juan Li
- Clinical Skill Training Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yongzhi Xia
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dong Zhong
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuedong Wu
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dahai He
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dongjie Shi
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiong Li
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaochuan Sun
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Yin X, Duan H, Yi Z, Li C, Lu R, Li L. Incidence, Prognostic Factors and Survival for Hemangioblastoma of the Central Nervous System: Analysis Based on the Surveillance, Epidemiology, and End Results Database. Front Oncol 2020; 10:570103. [PMID: 33014882 PMCID: PMC7509109 DOI: 10.3389/fonc.2020.570103] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/14/2020] [Indexed: 12/16/2022] Open
Abstract
Background Hemangioblastomas are uncommon, benign neoplasms of the central nervous system (CNS). This study aims to evaluate the incidence, demographics, clinical characteristics, and prognosis of CNS hemangioblastomas using the data from the Surveillance, Epidemiology, and End Results (SEER) Program. Methods Univariate and multivariate analyses using the Cox proportional hazards model were employed to identify prognostic factors of overall survival. The Kaplan-Meier method was utilized to evaluate overall survival distribution by treatment modality. A nomogram was further built to predict survival at 3 and 5 years. Results The overall incidence rate of CNS hemangioblastomas was 0.141 per 100,000 person-years. Through univariate analysis and multivariate analyses, age between 60 and 79 years (HR = 3.697, p < 0.001), age greater than 80 years (HR = 12.318, p < 0.001), African American race (HR = 1.857, p = 0.003), multiple tumors (HR = 1.715, p < 0.001), and prior surgery (HR = 0.638, p = 0.013) were significantly associated with overall survival. Patients receiving surgery alone had better overall survival compared with patients receiving no treatment (p = 0.008) and patients receiving both surgery and radiotherapy (p = 0.002). The calibration plots demonstrated an excellent agreement between nomogram-predicted and actual survival. Conclusion In conclusion, age, race, tumor location, number of tumors, and prior surgery are prognostic factors for survival. Surgery was the most common modality and was suggested as an effective and optimal treatment. The proposed nomogram can predict the prognosis of patients with CNS hemangioblastomas and help clinicians in making decisions.
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Affiliation(s)
- Xiangdong Yin
- Department of Neurosurgery, Peking University First Hospital, Beijing, China
| | - Hongzhou Duan
- Department of Neurosurgery, Peking University First Hospital, Beijing, China
| | - Zhiqiang Yi
- Department of Neurosurgery, Peking University First Hospital, Beijing, China
| | - Chunwei Li
- Department of Neurosurgery, Peking University First Hospital, Beijing, China
| | - Runchun Lu
- Department of Neurosurgery, Peking University First Hospital, Beijing, China
| | - Liang Li
- Department of Neurosurgery, Peking University First Hospital, Beijing, China
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Splavski B, Zbytek B, Arnautovic KI. Surgical management and outcome of adult posterior cranial fossa and spinal hemangioblastoma: a 6-case series and literature review. Neurol Res 2020; 42:1010-1017. [PMID: 32697158 DOI: 10.1080/01616412.2020.1796382] [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] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Hemangioblastomas of the posterior cranial fossa and spinal cord in adults are excessively vascularized, well-differentiated, and scarce tumors with no metastatic potential. This paper discusses its surgical management and outcome, pointing out their morphological, radiological, and histopathological aspects. This report based on a personal series of six patients and on a literature review. METHODS A single-institution personal 6-case series of adult patients diagnosed and operated on by a senior neurosurgeon (KIA) due to posterior cranial fossa or spinal cord hemangioblastoma was analyzed. For easier understanding of hemangioblastoma, we have classified them into four different types. RESULTS The tumors, which were all surgically treated, were located in the posterior cranial fossa in five patients (4 cerebellar, 1 brain stem) and intramedullary in the thoracic spinal cord in one patient. All patients successfully recovered neurologically after a complete tumor resection, having no post-operative neurological deficit or other complications. CONCLUSION Surgical management of cerebellar and spinal cord hemangioblastoma in adults is highly dependent on its morphological features, as well as on microsurgical technique applied. Since huge differences exist between the cystic/nodular tumor type (Type 1) and the solid type and its two additional variants (Types 2-4), morphology is the most important consideration when deciding surgical approach. Despite significant morphological differences among different subtypes of hemangioblastomas, their histology appears to be relatively similar. Nonetheless, a meticulous and refined surgical technique has to be utilized to achieve a successful outcome.
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Affiliation(s)
- Bruno Splavski
- Department of Neurosurgery, Sestre Milosrdnice University Hospital Center , Zagreb, Croatia.,School of Dental Medicine and Health, J.J. Strossmayer University of Osijek , Osijek, Croatia.,J.J. Strossmayer University of Osijek School of Medicine , Osijek, Croatia
| | | | - Kenan I Arnautovic
- Department of Neurosurgery, University of Tennessee Health Science Center , Memphis, TN, USA.,Semmes Murphey Clinic , Memphis, TN, USA
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Kim EH, Moon JH, Kang SG, Lee KS, Chang JH. Diagnostic challenges of posterior fossa hemangioblastomas: Refining current radiological classification scheme. Sci Rep 2020; 10:6267. [PMID: 32286416 PMCID: PMC7156704 DOI: 10.1038/s41598-020-63207-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 03/26/2020] [Indexed: 11/29/2022] Open
Abstract
Hemangioblastomas (HBMs) are known to exhibit very typical radiological features and thus classified by well-established radiological classification scheme. We reviewed our series of posterior fossa HBMs in order not only to evaluate the relevance of current classification scheme, but also to possibly refine it. Also, we added descriptions on several cases with unusual radiological magnetic resonance imaging (MRI) findings in which differential diagnosis was challenging. We retrospectively reviewed preoperative MRI of 118 patients with pathologically diagnosed posterior fossa HBMs at our institution between 2002 and 2015. Total 128 tumors were included to this study and classified into four categories based on the presence and nature of cystic components: extratumoral cystic (Type Ce, classical cystic with a mural nodule), intratumoral cystic (Type Ci), mixed cystic (Type Cm), and solid (Type S). The association with von Hippel-Lindau (VHL) disease was also investigated. In 118 patients (65 male and 53 female), 79 (66.9%) had solitary HBMs and 39 (33.1%) were diagnosed with VHL disease. Type Ce with typical radiological findings was the most prevalent type of HBM (63.3%), followed by Type S (21.1%). HBMs with intratumoral cysts were uncommon (Type Ci, 11.7%) and mixed extratumoral and intratumoral cysts (Type Cm) accounted for only 3.9%. No intergroup differences were observed in the proportions of each subtype between the solitary and VHL disease-associated HBMs. The blood loss was much lower in Type Ce than in other subtypes. In Type Cm, radical resection was often challenging as the differentiation between intratumoral and extratumoral cysts was difficult resulting in incomplete resection. Refined radiological classification scheme is more practical because it does not only help surgeons determine whether the cystic wall should be removed or not, but also covers cases with atypical radiological presentations. For solid and extraparenchymal HBMs, differential diagnosis is more difficult as well as very critical as surgical removal is often very challenging.
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Affiliation(s)
- Eui Hyun Kim
- Department of Neurosurgery, Brain Tumor Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ju Hyung Moon
- Department of Neurosurgery, Brain Tumor Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seok-Gu Kang
- Department of Neurosurgery, Brain Tumor Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyu Sung Lee
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Brain Tumor Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Chang H, Li J, Wang P, Lu X, Li B. Microsurgical treatment of cervical spinal hemangioblastoma. Neurochirurgie 2020; 66:56-60. [DOI: 10.1016/j.neuchi.2019.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 11/02/2019] [Accepted: 11/03/2019] [Indexed: 11/28/2022]
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Gao Q, Zhang L, Wang G, Xu D, Feng M, Wang F, Wei Q, Liu X, Guo F. A novel neuroimaging assessment of predictive risk factors associated with intraoperative massive hemorrhage in intracranial solid hemangioblastoma. Quant Imaging Med Surg 2019; 9:1781-1791. [PMID: 31867232 DOI: 10.21037/qims.2019.09.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background A solid hemangioblastoma (SH) is a benign and highly vascularized tumor. Microsurgical treatment of SH is still challenging due to excessive intraoperative bleeding. Methods Sixty-six consecutive patients with SH were retrospectively analyzed. The volume of intraoperative blood loss (IBL) and the features detected by magnetic resonance imaging (MRI) were evaluated by a neurosurgeon and multiple neuroradiologists. Results Four striking MRI features-peritumoral edema, the flow-void effect, large draining veins, and a visible feeding artery-were related to excessive IBL. Regarding the weighted values of these risk factors, the flow-void effect was the factor most significantly correlated with IBL (P<0.01, R=0.418). The feeding artery also contributed substantially to excessive IBL (P<0.05, R=0.412). The next most influential factor was the presence of large draining veins (P<0.05, R=0.350), followed by peritumoral edema (P<0.05, R=0.308). The four major risk factors-the flow-void effect, feeding arteries, large draining veins, and peritumoral edema-were assigned point values of 3, 3, 2, and 1, respectively, for a maximum total score of 9 points. A higher total score indicates that a higher volume of bleeding is more likely to occur during surgery. Conclusions This study reports the potential neuroimaging-based risk factors leading to abundant IBL in SH by neuroimaging assessment. The study proposes a novel scoring system to predict IBL, potentially decreasing the risk involved in the surgical treatment of SH.
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Affiliation(s)
- Qiang Gao
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Lan Zhang
- Department of MRI, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450003, China
| | - Guoqing Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Dingkang Xu
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Mengzhao Feng
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Fang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Qingjie Wei
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Xianzhi Liu
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Fuyou Guo
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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Wang Q, Cheng J, Zhang S, Ju Y, Liu W, Hui X. Central nervous system hemangioblastomas in the elderly (over 65 years): Clinical characteristics and outcome analysis. Clin Neurol Neurosurg 2019; 189:105622. [PMID: 31805489 DOI: 10.1016/j.clineuro.2019.105622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/21/2019] [Accepted: 11/24/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Hemangioblastomas (HBs) in the elderly are very uncommon and have rarely been studied. This retrospective study aimed to identify clinical features, optimal treatment, surgical outcomes and long-term prognostic factors in these rare lesions. PATIENTS AND METHODS We performed a retrospective analysis of HBs patients over 65 years old who underwent surgery from 2008 to 2018 at our department. Clinical data was retrospectively reviewed and statistically analyzed. RESULTS Thirty-three elderly patients with a mean age of 68.76 years were included in this study. Cerebellum, brainstem, and spinal cord locations accounted for 72.7 %, 18.2 % and 9.1 %. Two patients (6.1 %) were diagnosed as von Hippel-Lindau (VHL) syndrome. After mean follow-up of 37.95 ± 22.12 months, clinical symptoms improved in 22 patients (67 %), unchanged in seven patients (21 %) and aggravated in 4 patients (12 %). Only 1(3 %) patient experienced local recurrence during follow-up. Univariate analysis showed tumor size (P = 0.044) and tumor characteristic (cystic or solid) (P = 0.034) were significantly related to long-term outcomes, while multiple logistic regression analysis depicted tumor characteristics were exclusively correlated with outcomes (P = 0.04). CONCLUSIONS Our study suggests elderly hemangioblastomas may be different from their younger counterparts in that they often display solid configuration with large size and include more cerebellar tumors. HBs should be included in the differential diagnosis of elderly patients presenting with cerebellar mass. Despite many challenges involved, surgical removal of HBs in this age group is a safe procedure with acceptable risks. They may do not require as frequent follow-up as younger counterparts due to the low associations with VHL disease and tumor recurrence rate.
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Affiliation(s)
- Qiguang Wang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Jian Cheng
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Si Zhang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yan Ju
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Wenke Liu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xuhui Hui
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
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Abstract
RATIONALE Hemangioblastoma (HB) is a benign tumor that is typically located in the subtentorial region of the brain. HB that originates from dura mater is extremely rare. PATIENT CONCERNS Herein, we reported a single case of a patient who presented with dizziness and headache lasting for 1 year that progressively aggravated within 1 month. DIAGNOSIS After admission, the patient underwent head magnetic resonance (MR); a nodular long T1-T2 signal was found on the right side of parietal falx cerebri; the lesion appeared with high intensity on FLAIR and DWI, and with isointensity on ADC map. In addition, significant homogeneous enhancements were observed on the enhanced scan. According to clinical and imaging features, the lesion was diagnosed as meningioma. However, after performing tumor resection by craniotomy, the diagnosis of HB is clear. Additional pathological examination data were found: Ki-67(+1%), NSE(-), CD31(+), CD34(+), CD56(+), S-100(-), α-inhibin(+), Vimentin(-), EGFR-), GFAP(-), CK-pan(-), EMA(-), PR(-). INTERVENTIONS The mass with abundant blood supply was removed. OUTCOMES Ten days after operation, the patient was discharged from hospital and no signs of recurrence were observed three months later. LESSONS To sum up, obvious high signal intensity in T2WI sequence and homogeneous enhancement are main characteristics that differentiate dural hemangioblastoma from meningioma lesion.
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Affiliation(s)
- Bingyang Bian
- Department of Radiology, First Hospital of Jilin University
| | - Bei Zhang
- Department of Radiology, First Hospital of Jilin University
| | - Hongli Zhou
- Department of Nephrology, Second Hospital of Jilin University
| | - Junwei Tian
- Department of Bone and Joint Surgery, First Hospital of Jilin University, China
| | - Zhuo Wang
- Department of Radiology, First Hospital of Jilin University
| | - Jiping Wang
- Department of Radiology, First Hospital of Jilin University
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Kawauchi D, Higuchi Y, Ikegami S, Adachi A, Ozaki K, Suda I, Kobayashi E, Iwadate Y. Unilateral Occipital Transtentorial Approach with Multimodal Assistance for Resection of Large Supracerebellar Hemangioblastomas: Preliminary Experience of 2 Cases. World Neurosurg 2019; 129:e733-e740. [PMID: 31285176 DOI: 10.1016/j.wneu.2019.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/31/2019] [Accepted: 06/01/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The surgical resection of large supracerebellar hemangioblastomas (SHBs) is exceptionally challenging due to their vascularity and deep anatomic location and is associated with a high risk of postoperative complications and mortality. Access to the posterior incisural space can be achieved by either an infratentorial supracerebellar approach or occipital transtentorial approach (OTA). However, the optimal surgical strategy has not yet been established. Here, we report 2 cases of large SHBs that were successfully and safely resected via a unilateral OTA with multimodal assistance. CASE DESCRIPTION Two patients presented to our hospital with ataxia due to large, solid SHBs. After preoperative embolization, gross total resection of the SHBs was achieved via an OTA. Furthermore, endoscopic assistance was used to resect the remnant portion of the tumor in the second patient. Both patients experienced transient ataxia but were discharged from the hospital without serious complications. CONCLUSIONS The combination of an OTA with preoperative embolization and endoscopic assistance may reduce the intraoperative risk and contribute to improved outcome in patients with such clinically challenging tumors.
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Affiliation(s)
- Daisuke Kawauchi
- Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
| | - Yoshinori Higuchi
- Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Shiro Ikegami
- Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Akihiko Adachi
- Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Ko Ozaki
- Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Izumi Suda
- Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Eiichi Kobayashi
- Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yasuo Iwadate
- Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
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Pojskic M, Arnautovic KI. Microsurgical Resection of Medulla Oblongata Hemangioblastoma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2018; 15:E64-E65. [PMID: 29635302 PMCID: PMC6195172 DOI: 10.1093/ons/opy074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/16/2018] [Indexed: 11/30/2022] Open
Abstract
This video demonstrates the microsurgical resection of brainstem hemangioblastoma. The patient is a 32-yr-old woman with Von Hippel Lindau syndrome who presented with quadriparesis and inability to swallow. Magnetic resonance imaging (MRI) of the neuroaxis revealed a brainstem cystic lesion with contrast-enhancing tumor nodule right along the posterior aspect of the lower part of medulla oblongata. The surgery was performed in the prone position with suboccipital craniectomy and partial C1 posterior arch removal. The aim of the surgery was to remove the tumor nodule.1-12 The tumor was separated from the right dorsal nerve roots, and then progressively dissected with coagulation of arterial feeders and draining vein and division of the pia circumferentially. Postoperative MRI revealed complete resection. The patient completely recovered from her quadriparesis and difficulty swallowing.
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Affiliation(s)
- Mirza Pojskic
- Department of Neurosurgery, University of Marburg, Marburg, Germany
| | - Kenan I Arnautovic
- Semmes Murphey Neurologic & Spine Institute, Memphis, Tennessee.,Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
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Nguyen HS, Doan NB, Gelsomino M, Shabani S, Awad AJ, Kaushal M, Mortazavi MM. Intracranial hemangioblastoma - A SEER-based analysis 2004-2013. Oncotarget 2018; 9:28009-28015. [PMID: 29963258 PMCID: PMC6021332 DOI: 10.18632/oncotarget.25534] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/14/2018] [Indexed: 02/02/2023] Open
Abstract
Introduction Intracranial hemangioblastoma (HB) is a rare pathology. Limited data exist regarding its epidemiology. Methods With the SEER-18 registry database, information from all patients diagnosed with intracranial HB from 2004 to 2013 were extracted, including age, gender, race, marital status, presence of surgery, extent of surgery, receipt of radiation, tumor size, tumor location, and follow-up data. Age-adjusted incidence rates and overall survival (OS). Cox proportional hazards model was employed for both univariate and multivariate analyses. Results A total of 1307 cases were identified. The overall incidence of intracranial hemangioblastoma is 0.153 per 100,000 person-years [95% confidence interval (CI)=0.145–0.162]. Through univariate analysis, age < 40 [hazard ratio (HR)=0.277, p<0.001], no radiation [HR=0.56, p=0.047], and presence of surgery [HR=0.576, p=0.012] are significant positive prognostic factors. Caucasian race [HR=1.42, p=0.071] and female gender [HR=0.744, p=0.087] exhibit noticeable trends towards positive prognosis. Through multivariate analysis, younger age [HR=1.053, p < 0.01], race [HR=1.916, p<0.01], and presence of surgery [HR=0.463, p<0.01 were significant independent prognostic factors. Conclusion Clinical factors such as younger age, Caucasian race, and presence of surgery are significant independent factors for overall survival in patients with HBs. Though analysis regarding extent of surgery did not produce a meaningful relationship, this may be related to surgical bias / expertise. Moreover, no validation for radiation therapy was identified, but this may be related to short follow up intervals and the variable growth patterns of HBs.
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Affiliation(s)
- Ha Son Nguyen
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,California Institute of Neuroscience, Thousand Oaks, California, USA
| | - Ninh B Doan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Department of Neurosurgery, University of South Alabama, Mobile, Alabama, USA
| | - Michael Gelsomino
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Saman Shabani
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ahmed J Awad
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Mayank Kaushal
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Martin M Mortazavi
- National Skull Base Center, Thousand Oaks, California, USA.,California Institute of Neuroscience, Thousand Oaks, California, USA
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