1
|
Fabi F, Chamberland È, D’Astous M, Michaud K, Côté M, Thibault I. Radiosurgically Treated Recurrent Cerebellar Hemangioblastoma: A Case Report and Literature Review. Curr Oncol 2024; 31:3968-3977. [PMID: 39057165 PMCID: PMC11276307 DOI: 10.3390/curroncol31070293] [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: 05/29/2024] [Revised: 06/25/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Cystic, sporadic hemangioblastomas (HBLs) represent a unique, therapeutically challenging subset of central nervous system tumors, mainly due to their unpredictable growth patterns and potential for symptomatic progression. This study aims to explore the complexities surrounding the diagnosis, treatment, and long-term management of these lesions. METHODS A comprehensive literature review was performed, and a detailed case study of a 56-year-old patient with a cystic, sporadic cerebellar HBL was produced. RESULTS The case highlights the multiphasic growth pattern typical of cystic, sporadic HBLs, characterized by periods of dormancy and subsequent rapid expansion. An initial surgical intervention offered temporary control. Tumor recurrence, mainly through cystic enlargement, was treated by SRS. A subsequent recurrence, again caused by cystic growth, eventually led to the patient's death. The intricacies of treatment modalities, focusing on the transition from surgical resection to stereotactic radiosurgery (SRS) upon recurrence, are discussed. Parameters indicating impending tumor growth, coupled with symptomatic advances, are also explored. CONCLUSIONS The management of cystic, sporadic cerebellar HBLs requires a strategic approach that can be informed by radiological characteristics and tumoral behavior. This study underscores the importance of a proactive, individualized management plan and suggests guidelines that could inform clinical decision making.
Collapse
Affiliation(s)
- François Fabi
- Service de Radio-Oncologie du Département de Médecine Spécialisée, Centre Intégré de Cancérologie (CIC), Hôpital de l’Enfant-Jésus, Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Quebec City, QC G1J 1Z4, Canada;
| | - Ève Chamberland
- Service de Physique Médicale et de Radioprotection, CHU de Québec-Université Laval, Quebec City, QC G1J 1Z4, Canada
| | - Myreille D’Astous
- Service de Neurochirurgie du Département de Chirurgie, Hôpital de l’Enfant-Jésus, CHU de Québec-Université Laval, Quebec City, QC G1J 1Z4, Canada
| | - Karine Michaud
- Service de Neurochirurgie du Département de Chirurgie, Hôpital de l’Enfant-Jésus, CHU de Québec-Université Laval, Quebec City, QC G1J 1Z4, Canada
| | - Martin Côté
- Service de Neurochirurgie du Département de Chirurgie, Hôpital de l’Enfant-Jésus, CHU de Québec-Université Laval, Quebec City, QC G1J 1Z4, Canada
| | - Isabelle Thibault
- Service de Radio-Oncologie du Département de Médecine Spécialisée, Centre Intégré de Cancérologie (CIC), Hôpital de l’Enfant-Jésus, Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Quebec City, QC G1J 1Z4, Canada;
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Bauman MM, Bouchal SM, Kerezoudis P, Cloft H, Brinjikji W, Peris Celda M, Link MJ, Parney IF. Embolization of Large and Giant Posterior Fossa Hemangioblastomas: The Experience of a Single Tertiary Care Center. J Neurol Surg B Skull Base 2023; 84:598-608. [PMID: 37854530 PMCID: PMC10581830 DOI: 10.1055/a-1946-4604] [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: 07/15/2022] [Accepted: 09/13/2022] [Indexed: 10/14/2022] Open
Abstract
Background Hemangioblastomas pose an inherent surgical risk due to the potential for high intraoperative blood loss, especially in larger tumors. One approach to minimize this risk is to use preoperative embolization. Herein, we present our institutional experience treating large and giant cerebellar hemangioblastomas. Methods We performed a retrospective chart review of 19 patients with cerebellar hemangioblastomas that had a maximal diameter of >3 cm. We performed a literature review and included individual patient-level data that met our >3 cm diameter cerebellar hemangioblastoma inclusion criteria. Results Our cohort consisted of 19 patients that received a total of 20 resections for their cerebellar hemangioblastomas. Preoperative embolization was utilized in eight cases (38.1%). One patient experienced transient neurological complications after embolization (12.5%). Tumors of patients in the embolization group had larger median total, solid, and cystic volumes and were more likely to involve the cerebellopontine angle than those in the non-embolized group. Compared with non-embolized patients, embolized patients had less decrease in their hemoglobin, lower volumes of estimated blood loss, reduced rates of postoperative complications and permanent deficits, and greater instances of neurological improvement. The larger cohort (obtained from the combining our cohort with patients identified during a literature review) consisted of 99 patients with 39 receiving preoperative embolization. Conclusion It is important to examine individual patient characteristics when determining eligibility for preoperative embolization. However, improvements in endovascular techniques have made preoperative embolization a safe and effective procedure with minimal risks that can be performed in many patients.
Collapse
Affiliation(s)
- Megan M.J. Bauman
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Samantha M. Bouchal
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | | | - Harry Cloft
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States
| | - Maria Peris Celda
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Michael J. Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Ian F. Parney
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| |
Collapse
|
4
|
Zhang H, Jiang X, Ren F, Gu Q, Yao J, Wang X, Zou S, Gan Y, Gu J, Xu Y, Wang Z, Liu S, Wang X, Wei B. Development and external validation of dual online tools for prognostic assessment in elderly patients with high-grade glioma: a comprehensive study using SEER and Chinese cohorts. Front Endocrinol (Lausanne) 2023; 14:1307256. [PMID: 38075045 PMCID: PMC10702965 DOI: 10.3389/fendo.2023.1307256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023] Open
Abstract
Background Elderly individuals diagnosed with high-grade gliomas frequently experience unfavorable outcomes. We aimed to design two web-based instruments for prognosis to predict overall survival (OS) and cancer-specific survival (CSS), assisting clinical decision-making. Methods We scrutinized data from the SEER database on 5,245 elderly patients diagnosed with high-grade glioma between 2000-2020, segmenting them into training (3,672) and validation (1,573) subsets. An additional external validation cohort was obtained from our institution. Prognostic determinants were pinpointed using Cox regression analyses, which facilitated the construction of the nomogram. The nomogram's predictive precision for OS and CSS was gauged using calibration and ROC curves, the C-index, and decision curve analysis (DCA). Based on risk scores, patients were stratified into high or low-risk categories, and survival disparities were explored. Results Using multivariate Cox regression, we identified several prognostic factors for overall survival (OS) and cancer-specific survival (CSS) in elderly patients with high-grade gliomas, including age, tumor location, size, surgical technique, and therapies. Two digital nomograms were formulated anchored on these determinants. For OS, the C-index values in the training, internal, and external validation cohorts were 0.734, 0.729, and 0.701, respectively. We also derived AUC values for 3-, 6-, and 12-month periods. For CSS, the C-index values for the training and validation groups were 0.733 and 0.727, with analogous AUC metrics. The efficacy and clinical relevance of the nomograms were corroborated via ROC curves, calibration plots, and DCA for both cohorts. Conclusion Our investigation pinpointed pivotal risk factors in elderly glioma patients, leading to the development of an instrumental prognostic nomogram for OS and CSS. This instrument offers invaluable insights to optimize treatment strategies.
Collapse
Affiliation(s)
- Hongyu Zhang
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xinzhan Jiang
- Department of Neurobiology, Harbin Medical University, Harbin, China
| | - Fubin Ren
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qiang Gu
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jiahao Yao
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xinyu Wang
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shuhuai Zou
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yifan Gan
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jianheng Gu
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yongji Xu
- Department of Neurosurgery, Hulin People’s Hospital, Jixi, Heilongjiang, China
| | - Zhao Wang
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Shuang Liu
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xuefeng Wang
- Department of Neurosurgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Baojian Wei
- School of Nursing, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, China
| |
Collapse
|
5
|
Chinchilla-Tábora LM, Ortiz Rodríguez-Parets J, Otero-Rodríguez Á, Ruiz Martín L, Paniagua Escudero JC, Navarro Martín LM, Cigarral García B, Nieto Palacios A, González Morais I, Sayagués JM, Ludeña de la Cruz MD. Cerebellar Hemangioblastoma with Leptomeningeal Spread and a Fatal Outcome: A Rare Case Report with MDM2 and EGFR Alterations. Int Med Case Rep J 2023; 16:709-714. [PMID: 37941973 PMCID: PMC10629408 DOI: 10.2147/imcrj.s428201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/21/2023] [Indexed: 11/10/2023] Open
Abstract
Hemangioblastoma (HB) is a Central Nervous System (CNS) tumor with a generally favorable behavior and prognosis, classified as WHO grade 1. Sporadic HB is not related to any inherited disease, and it usually appears in a single location. Sporadic or VHL-related HBs show variable patterns of growth velocity. Cases of growing HB can cause mild symptoms such as headache, but some cases develop serious complications such as accumulation of cerebrospinal fluid in the brain with secondary neurological damage sometimes being irreversible when early treatment is not started. Our case showed some clinical characteristics more frequently observed in VHL-related HB rather than sporadic HB, and the presence of alterations in MDM2 and EGFR that could be related to the oncogenesis of these tumors. Even when the treatment of choice for HB is surgery, the presence of these genetic alterations could open a new window for research aimed at assessing the possibility of new therapies with TKIs-EGFR and anti-MDM2 inhibitors in those HB cases with multifocal recurrences or cases with an adverse clinical behavior.
Collapse
Affiliation(s)
- Luis Miguel Chinchilla-Tábora
- Department of Pathology, University Hospital of Salamanca and Institute for Biomedical Research of Salamanca, Salamanca, Spain
| | - Javier Ortiz Rodríguez-Parets
- Department of Pathology, University Hospital of Salamanca and Institute for Biomedical Research of Salamanca, Salamanca, Spain
| | - Álvaro Otero-Rodríguez
- Department of Neurosurgery, University Hospital of Salamanca and Institute for Biomedical Research of Salamanca, Salamanca, Spain
| | - Laura Ruiz Martín
- Department of Neurosurgery, University Hospital of Salamanca and Institute for Biomedical Research of Salamanca, Salamanca, Spain
| | - Juan Carlos Paniagua Escudero
- Department of Radiology, University Hospital of Salamanca and Institute for Biomedical Research of Salamanca, Salamanca, Spain
| | - Luis Miguel Navarro Martín
- Department of Clinical Oncology, University Hospital of Salamanca and Institute for Biomedical Research of Salamanca, Salamanca, Spain
| | - Belén Cigarral García
- Department of Clinical Oncology, University Hospital of Salamanca and Institute for Biomedical Research of Salamanca, Salamanca, Spain
| | - Adelaida Nieto Palacios
- Department of Radiation Oncology, University Hospital of Salamanca and Institute for Biomedical Research of Salamanca, Salamanca, Spain
| | - Idalia González Morais
- Department of Pathology, University Hospital of Salamanca and Institute for Biomedical Research of Salamanca, Salamanca, Spain
| | - José María Sayagués
- Department of Pathology, University Hospital of Salamanca and Institute for Biomedical Research of Salamanca, Salamanca, Spain
| | - María Dolores Ludeña de la Cruz
- Department of Pathology, University Hospital of Salamanca and Institute for Biomedical Research of Salamanca, Salamanca, Spain
| |
Collapse
|
6
|
Sun Z, Jia R, Wang X, Pang X. Three-dimensional simulation/printing-assisted surgery for symptomatic metastatic epidural spinal cord compression of posterior column: efficacy assessment based on 2-year follow-up. Front Surg 2023; 10:1177280. [PMID: 37304181 PMCID: PMC10250737 DOI: 10.3389/fsurg.2023.1177280] [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: 03/01/2023] [Accepted: 05/04/2023] [Indexed: 06/13/2023] Open
Abstract
Background Surgical intervention is necessary for resolving the symptoms of the spinal cord and nerve compression caused by symptomatic metastatic epidural spinal cord compression. However, surgeons are constantly seeking ways to improve surgical efficiency and safety. This study aims to evaluate the efficacy of 3D simulation/printing-assisted surgery for symptomatic metastatic epidural spinal cord compression of the posterior column. Methods We retrospectively analyzed the clinical data of patients who underwent surgical treatment for symptomatic metastatic epidural spinal cord compression of the posterior column in our hospital from January 2015 to January 2020. The simulated group underwent a 3D digital simulation of the lesion area using imaging data before surgery. Twelve patients in the simulated group also received 3D printing, while the direct surgery group did not receive any 3D simulation or printing. All patients were followed up for at least 2 years. We collected clinical data, including operation time, intraoperative blood loss, pedicle screw adjustment rate, intraoperative fluoroscopy times, the incidence of dural injury and cerebrospinal fluid leakage, VAS score, postoperative neurological function improvement, and tumor recurrence. Statistical analysis was performed using SPSS23.0, and P < 0.05 was considered statistically significant. Results A total of 46 patients were included in this study, with 20 in the simulated group and 26 in the non-simulated group. The simulated group had better operation time, intraoperative blood loss, screw adjustment rate, fluoroscopy times, and incidence of dural injury/cerebrospinal fluid leakage compared to the non-simulated group. The VAS scores of the two groups improved significantly after the operation and at the last follow-up compared to before the operation. However, there was no statistically significant difference between the two groups. There was also no statistically significant difference in neurological function improvement between the two groups. In the simulated group, 25% of patients relapsed, while in the non-simulated group, 34.61% of patients relapsed. However, there was no statistical difference between the two groups. Conclusion Preoperative 3D simulation/printing-assisted surgery is a practical and feasible approach for treating symptomatic metastatic epidural spinal cord compression of the posterior column.
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Hovis GEA, Brown NJ, Ton E, Shahrestani S, Reveche H, Maddipatla V, Gendreau J, Golshani K. Bibliometric Analysis of the 100 Most Influential Hemangioblastoma Research Articles Illustrates Progress in Clinical Management and Room for Growth in Targeted Therapies. World Neurosurg 2022; 166:1-14. [PMID: 35779759 DOI: 10.1016/j.wneu.2022.06.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This bibliometric analysis aims to identify the most impactful articles on hemangioblastoma (HB) and evaluate the trajectory of academic literature in the field. METHODS The authors performed a title search using the Web of Science database, with ("hemangioblastoma" OR "haemangioblastoma") as a search query. The top 100 cited articles from the years 1900-2020 were sorted by the descending order of the total citation count. The following variables were assessed for each article: title, first author name and institution, publication year, country of origin, citation count, citations per year, and journal impact factor. RESULTS The query yielded 1918 articles related to the topic of HB that were published between the years 1900 and 2020 in 42 unique journals. The most prolific decade of publication was the 2000s (35%), followed by the 1990s (33%) and the 1980s (11%). The average citation count was 88.3 (range, 47-426), and the mean number of citations per year was 3.74 (range, 0.660-17.8). CONCLUSIONS This is the first bibliometric analysis to evaluate the most influential HB publications. Though a majority of HBs are sporadic, these results suggest a research focus on von Hippel-Lindau-associated tumors. Despite established evidence for the potential to control HB growth with vascular endothelial growth factor inhibition, there are no known clinical trials underway for this investigation. There is a need for consistent treatment guidelines for asymptomatic HBs, as resection can prevent the development of neurological deficits. An improved understanding of the etiology of these neoplasms could promote the development of novel diagnostic and treatment methods.
Collapse
Affiliation(s)
- Gabrielle E A Hovis
- Department of Neurological Surgery, University of California, Orange, California, USA
| | - Nolan J Brown
- Department of Neurological Surgery, University of California, Orange, California, USA.
| | - Emily Ton
- Department of Neurological Surgery, University of California, San Diego, California, USA
| | - Shane Shahrestani
- Department of Neurological Surgery, University of California, Orange, California, USA
| | - Hope Reveche
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Vishnu Maddipatla
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Julian Gendreau
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kiarash Golshani
- Department of Neurological Surgery, University of California, Orange, California, USA
| |
Collapse
|
9
|
Yoda RA, Cimino PJ. Neuropathologic features of central nervous system hemangioblastoma. J Pathol Transl Med 2022; 56:115-125. [PMID: 35501672 PMCID: PMC9119802 DOI: 10.4132/jptm.2022.04.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/13/2022] [Indexed: 12/04/2022] Open
Abstract
Hemangioblastoma is a benign, highly vascularized neoplasm of the central nervous system (CNS). This tumor is associated with loss of function of the VHL gene and demonstrates frequent occurrence in von Hippel-Lindau (VHL) disease. While this entity is designated CNS World Health Organization grade 1, due to its predilection for the cerebellum, brainstem, and spinal cord, it is still an important cause of morbidity and mortality in affected patients. Recognition and accurate diagnosis of hemangioblastoma is essential for the practice of surgical neuropathology. Other CNS neoplasms, including several tumors associated with VHL disease, may present as histologic mimics, making diagnosis challenging. We outline key clinical and radiologic features, pathophysiology, treatment modalities, and prognostic information for hemangioblastoma, and provide a thorough review of the gross, microscopic, immunophenotypic, and molecular features used to guide diagnosis.
Collapse
Affiliation(s)
- Rebecca A. Yoda
- Department of Laboratory Medicine and Pathology, Division of Neuropathology, University of Washington, Seattle, WA, USA
- Department of Laboratory Medicine and Pathology, Division of Cytopathology, University of Washington, Seattle, WA, USA
- Corresponding Author: Rebecca A. Yoda, MD, Department of Laboratory Medicine and Pathology, University of Washington, 325 9th Avenue, Box 359791, Seattle, WA 98104-2499, USA Tel: +1-206-744-3145, Fax: +1-206-744-8240, E-mail:
| | - Patrick J. Cimino
- Department of Laboratory Medicine and Pathology, Division of Neuropathology, University of Washington, Seattle, WA, USA
| |
Collapse
|
10
|
Lopes dos Santos A, Trevas S, Rosado ML. A Challenge in Diagnosis of Cerebellar Hemangioblastoma. Cureus 2022; 14:e21713. [PMID: 35242478 PMCID: PMC8884541 DOI: 10.7759/cureus.21713] [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] [Accepted: 01/28/2022] [Indexed: 12/03/2022] Open
Abstract
Hemangioblastomas are benign neoplasms, which are highly vascularized and have a slow-growing rate that typically affect the central nervous system; they account for about 1-2.5% of all intracranial tumors and for approximately 2-3% of all intramedullary neoplasms. We present a clinical case of cerebellar hemangioblastoma with six years of evolution, which illustrates the diagnostic difficulties that often arise, especially when the clinical and imaging characteristics escape those usually described and when other clinical findings appear as confounding factors. A 17-year-old female was initially admitted to the emergency department (ED) with a holocranial headache, gait imbalance, and vomiting. A brain magnetic resonance imaging (MRI) was done and a rounded lesion was detected in the left cerebellar hemisphere, hypointense in T1 and hyperintense in T2, with annular contrast enhancement. Several hypotheses for diagnosis were made, and the patient was subjected to several therapies, with periods of remission of symptoms interleaved with periods of worsening. After imaging suggestive of hemangioblastoma on routine brain MRI, the tumor was excised surgically and the histopathology confirmed the diagnosis. In the control brain MRI exams performed six and 24 months after surgery, no evidence of tumor recurrence was detected, and the patient remained asymptomatic. In conclusion, although these are rare neoplasms, it is essential to always consider hemangioblastomas in the differential diagnosis of cases with compatible clinical and radiological findings. A wrong or late diagnosis may lead to the use of unnecessary and harmful therapies as well as the appearance of potentially preventable complications if these tumors are handled correctly and timely.
Collapse
|
11
|
He J, Liu N, Liu W, Zhou W, Wang Q, Hu H. CT and MRI characteristic findings of sporadic renal hemangioblastoma: Two case reports. Medicine (Baltimore) 2021; 100:e24629. [PMID: 33578578 PMCID: PMC7886462 DOI: 10.1097/md.0000000000024629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/15/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Hemangioblastomas in the kidney are rare. Although a few cases of renal hemangioblastoma (RH) have been reported, the content of these articles mainly focused on clinical and pathological research, with minimal descriptions of radiologic findings. Moreover, there are no descriptions of magnetic resonance imaging (MRI) with enhancement of this condition. Herein, we report 2 cases of RH with computed tomography (CT) and MRI findings. PATIENT CONCERNS Two patients presented to our institution because of dull pain in the left abdomen, and a mass in the left kidney was found by ultrasound examination in each case. The patient had no special family history. Physical examination revealed no obvious tenderness or percussion pain in the renal and ureteral walking areas, and there was no obvious mass. Routine blood and urine tests were normal, and the serum tumor markers were negative. No obvious lesions were found on imaging of the other body parts. DIAGNOSIS Similar radiologic findings were observed in both cases and mimicked those of cavernous hemangiomas of the liver, including peripheral nodular enhancement in the corticomedullary phase, progressive centripetal enhancement in the nephrographic and delayed phases, and occasional complete "filling in" in the delayed phase. We made a radiologic diagnosis of renal clear cell carcinoma for patient 1 and suspected renal clear cell carcinoma for patient 2, but the pathological results showed RH. INTERVENTIONS Given the suspicion of renal cell carcinoma, both patients underwent partial nephrectomy. OUTCOME The recovery of the two patients was uneventful, and there was no evidence of local recurrence or metastasis many years after surgery. LESSONS RH is a rare benign tumor that can be easily misdiagnosed as clear cell carcinoma. Characteristic CT and MRI manifestations may improve preoperative diagnostic accuracy to avoid surgery or indicate nephron-sparing surgery.
Collapse
Affiliation(s)
| | - Nan Liu
- Department of Critical Care Medicine
| | - Wangwang Liu
- Department of Pathology, Sir Run Run Shaw Hospital
| | | | - Qiangfeng Wang
- Department of Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | | |
Collapse
|
12
|
Healy V, O'Halloran PJ, Husien MB, Bolger C, Farrell M. Intermixed arteriovenous malformation and hemangioblastoma: case report and literature review. CNS Oncol 2020; 9:CNS66. [PMID: 33244995 PMCID: PMC7737198 DOI: 10.2217/cns-2020-0021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/27/2020] [Indexed: 12/14/2022] Open
Abstract
We report the third presentation of an intermixed arteriovenous malformation and hemangioblastoma. The rare occurrence of the diagnostic histologic features of both a neoplasm and vascular malformation in a single lesion is more common in gliomas, as angioglioma, and is termed an 'intermixed' lesion. We review the literature concerning the developmental biology of each lesion, and potential interplay in the formation of an intermixed vascular neoplasm and vascular malformation. The roles of cellular origin, genetic susceptibility, favourable microenvironment, altered local gene expression and key regulatory pathways are reviewed. Our review supports angiography and genetic profiling in intermixed lesions to inform management strategies. Consideration should be given to multimodality therapeutic interventions as required, including microsurgical resection, stereotactic radiosurgery and further research to exploit emerging molecular targets.
Collapse
Affiliation(s)
- Vincent Healy
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
- Department of Neuroscience, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Philip J O'Halloran
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
- Department of Neuroscience, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Ciaran Bolger
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
- Department of Neuroscience, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Michael Farrell
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
| |
Collapse
|
13
|
Pitsika M, Pexas G, Joshi A, Mitchell P. Solid Component Volume as a Proxy to Identify Distinct Hemangioblastoma Populations. World Neurosurg 2020; 146:e664-e669. [PMID: 33152496 DOI: 10.1016/j.wneu.2020.10.155] [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: 09/25/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Posterior fossa hemangioblastomas usually consist of a small solid nodule with a large cyst, while more rarely they present as a large solid mass with a small or absent cyst, which can be surgically challenging. We sought to investigate the potential existence of multiple distinct hemangioblastoma populations using tumor volumetric data as an indicator. METHODS We conducted a retrospective review of surgically treated hemangioblastomas between 2005 and 2019 in our unit, including clinical notes, preoperative magnetic resonance imaging volumetric analysis of the solid component of the tumor, and pathology. Finite Gaussian mixture modeling was applied on the solid component volume dataset to identify potential underlying Gaussian distributions with their associated characteristics. Nonparametric Mann-Whitney U tests were used to investigate significance of differences (P < 0.05) in solid component volume and different variables (Von Hippel-Lindau disease, extent of resection, outcome). RESULTS A total of 68 consecutive patients were included. Solid component volumes followed a multimodal distribution (median = 1287 mm3, interquartile range of 3428 mm3). The best-fit finite Gaussian mixture modeling model identified 3 statistically significant different (P = 0.001) potential mixture components: X1 (219 ± 187 mm3), X2 (2686 ± 1299 mm3), and X3 (10,800 ± 5514 mm3). The second-best model detected 2 significantly different (P = 9.99e-08) mixture components Y1 (222 ± 189 mm3) and Y2 (5391 ± 5094 mm3). A significant difference in solid component volume was found between patients with favorable and unfavorable outcome (P = 0.002). CONCLUSIONS This study has shown preliminary evidence that large solid hemangioblastomas may constitute a completely distinct population, rather than a variant of one large group of hemangioblastomas.
Collapse
Affiliation(s)
- Marina Pitsika
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle University Teaching Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
| | - Georgios Pexas
- Agriculture, School of Natural and Environmental Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Abhijit Joshi
- Department of Neuropathology, Royal Victoria Infirmary, Newcastle University Teaching Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Patrick Mitchell
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle University Teaching Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
14
|
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.
Collapse
|