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Colamaria A, Fochi NP, Laguado YAD, Blagia M, Leone A, Carbone F. Cervical intra and extramedullary hemangioblastoma with associated syringomyelia: A case report and review of the literature. Surg Neurol Int 2022; 13:448. [PMID: 36324962 PMCID: PMC9609879 DOI: 10.25259/sni_814_2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/15/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Spinal hemangioblastoma (HB) is a highly vascularized tumor commonly presenting in the lower thoracic and lumbar segments. It typically causes spinal compression, extensive bleeding, and/or syringomyelia. Case Description: A 32-year-old female presented with persistent headaches with a cervical MRI showing an intradural and extradural mass extending from the obex to C2. Following surgical tumor resection, the patient’s symptoms resolved. Conclusion: Resection of spinal HB requires direct removal of the tumor mass as the accompanying cystic components typically spontaneously regress.
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Affiliation(s)
| | | | | | - Maria Blagia
- Department of Neurosurgery, Giovanni XXIII Hospital, Bari, Italy,
| | - Augusto Leone
- Department of Neurosurgery, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
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Corvino S, Mariniello G, Corazzelli G, Franca R, Caro MBD, Maiuri F. Spinal cervical extradural hemangioblastoma. J Craniovertebr Junction Spine 2022; 13:192-197. [PMID: 35837434 PMCID: PMC9274673 DOI: 10.4103/jcvjs.jcvjs_146_21] [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: 11/23/2021] [Accepted: 05/08/2022] [Indexed: 12/04/2022] Open
Abstract
Spinal cervical extradural and intra-extradural hemangioblastomas are exceptional, with only nine reported cases. This study reviews the diagnostic and surgical problems of this rare entity. Two female patients, aged 80 years and 25 years, respectively, one with Von Hippel–Lindau disease (VHLD), experienced brachial pain and weakness. On magnetic resonance imaging, a dumbbell intra-extraspinal hemangioblastoma was evidenced. The surgical resection through posterior laminectomy resulted in clinical remission of brachial pain and weakness. The magnetic resonance aspect of a dumbbell lesion suggests a neurogenic tumor; the correct preoperative diagnosis is possible in individuals with VHLD. The surgical problems include high tumor vascularity, vertebral artery control, and nerve root preservation. However, the surgical excision results in clinical remission.
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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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Piquer-Belloch J, Rodríguez-Mena R, Llácer-Ortega JL, Riesgo-Suárez P, Rovira-Lillo V, Flor-Goikoetxea Gamo A, Cremades-Mira A, Llopis-San Juan E. A pure extradural hemangioblastoma mimicking a dumbbell nerve sheath tumor in cervical spine: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE2192. [PMID: 36131580 PMCID: PMC9563648 DOI: 10.3171/case2192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/10/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Spinal extradural hemangioblastomas (HBs) are quite uncommon, with most reported cases involving the thoracic and lumbar areas. Therefore, the presence of a dumbbell-shaped pure extradural cervical HB is exceptional, making preoperative diagnosis particularly challenging. OBSERVATIONS The authors report a case of a 27-year-old woman who presented to their outpatient clinic with progressive cervicobrachialgia and numbness in the left arm. Magnetic resonance imaging showed a C5–6 intradural extramedullary lesion, and, despite some atypical features, the diagnosis of a possible neurogenic tumor was made. A multidetector computed tomography scan and angiography confirmed the expansion and remodeling of the left neural foramen as well as the highly vascularized nature of the mass. Preoperative embolization of the lesion was performed. Complete tumor resection was accomplished, followed by a C5–6 posterior fusion. Histopathology and immunohistochemistry revealed an HB. LESSONS HBs should be considered among the differential diagnosis of cervical extradural tumors. Exhaustive preoperative workup and surgical planning are decisive in order to attain gross-total resection with favorable outcomes.
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Kim JH, Joo SM, Cho YE, Ha SW, Suh SH. Percutaneous Onyx Embolization of Recurrent Cervical Nerve Root Hemangioblastoma : A Case Report and Review of the Literature. Clin Neuroradiol 2021; 31:1209-1213. [PMID: 33999212 DOI: 10.1007/s00062-021-01023-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/15/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Jae Ho Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - Seung-Moon Joo
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - Yong Eun Cho
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - Sang Woo Ha
- Department of Neurosurgery, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea (Republic of)
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of).
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6
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Pojskić M, Zbytek B, Mutrie CJ, Arnautović KI. SPINAL DUMBBELL EPIDURAL HEMANGIOMA: TWO STAGE/SAME SITTING/SAME POSITION POSTERIOR MICROSURGICAL AND TRANSTHORACIC ENDOSCOPIC RESECTION - CASE REPORT AND REVIEW OF THE LITERATURE. Acta Clin Croat 2018; 57:797-808. [PMID: 31168222 PMCID: PMC6544093 DOI: 10.20471/acc.2018.57.04.27] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 11/20/2018] [Indexed: 12/16/2022] Open
Abstract
- Spinal dumbbell tumors are defined by a narrowing at the point where they penetrate the intervertebral foramina or dura mater, assuming an hourglass or dumbbell shape. Dumbbell-shaped spinal hemangiomas are extremely rare. We describe a dumbbell spinal tumor (epidural cavernous hemangioma) resected by a 2-stage single-sitting combined approach. We also conduct a substantial literature review of the subject. We present a case of a 78-year-old male who was found to have a homogeneously enhancing, dumbbell-shaped, intraspinal, extradural tumor mass extending into the left chest cavity. The tumor was resected with a single-sitting 2-stage posterior technique: a microsurgical approach, followed by endoscopic resection via a thoracoscopic approach. There are several reports in the literature on the combined approach for dumbbell tumors of the spinal cord. Our case is the first to describe 2-stage combined surgery in 1 sitting for dumbbell hemangioma with the patient in the lateral decubitus position for the thoracoscopic part of the surgery; and the use of a fat pad, which was applied in the neuroforamen via the posterior route, as a marker for resection during the transthoracic procedure.
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Affiliation(s)
- Mirza Pojskić
- 1Department of Neurosurgery, University of Marburg, Marburg, Germany; 2Pathology Group of Midsouth, Memphis, TN, USA; 3Baptist Memorial Group Thoracic Surgery, Memphis, TN, USA; 4Semmes Murphey Neurologic & Spine Institute and Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Blazej Zbytek
- 1Department of Neurosurgery, University of Marburg, Marburg, Germany; 2Pathology Group of Midsouth, Memphis, TN, USA; 3Baptist Memorial Group Thoracic Surgery, Memphis, TN, USA; 4Semmes Murphey Neurologic & Spine Institute and Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Christopher J Mutrie
- 1Department of Neurosurgery, University of Marburg, Marburg, Germany; 2Pathology Group of Midsouth, Memphis, TN, USA; 3Baptist Memorial Group Thoracic Surgery, Memphis, TN, USA; 4Semmes Murphey Neurologic & Spine Institute and Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kenan I Arnautović
- 1Department of Neurosurgery, University of Marburg, Marburg, Germany; 2Pathology Group of Midsouth, Memphis, TN, USA; 3Baptist Memorial Group Thoracic Surgery, Memphis, TN, USA; 4Semmes Murphey Neurologic & Spine Institute and Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
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7
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Extraneuraxial Hemangioblastoma: Clinicopathologic Features and Review of the Literature. Adv Anat Pathol 2018; 25:197-215. [PMID: 29189208 DOI: 10.1097/pap.0000000000000176] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Extraneuraxial hemangioblastoma occurs in nervous paraneuraxial structures, somatic tissues, and visceral organs, as part of von Hippel-Lindau disease (VHLD) or in sporadic cases. The VHL gene plausibly plays a key role in the initiation and tumorigenesis of both central nervous system and extraneuraxial hemangioblastoma, therefore, the underlying molecular and genetic mechanisms of the tumor growth are initially reviewed. The clinical criteria for the diagnosis of VHLD are summarized, with emphasis on the distinction of sporadic hemangioblastoma from the form fruste of VHLD (eg, hemangioblastoma-only VHLD). The world literature on the topic of extraneuraxial hemangioblastomas has been comprehensively reviewed with ∼200 cases reported to date: up to 140 paraneuraxial, mostly of proximal spinal nerve roots, and 65 peripheral, 15 of soft tissue, 6 peripheral nerve, 5 bone, and 39 of internal viscera, including 26 renal and 13 nonrenal. A handful of possible yet uncertain cases from older literature are not included in this review. The clinicopathologic features of extraneuraxial hemangioblastoma are selectively presented by anatomic site of origin, and the differential diagnosis is emphasized in these subsets. Reference is made also to 10 of the authors' personal cases of extraneuraxial hemangioblastomas, which include 4 paraneuraxial and 6 peripheral (2 soft tissue hemangioblastoma and 4 renal).
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Abstract
STUDY DESIGN One hundred twenty-four patients with spinal dumbbell tumors were analyzed retrospectively using a new classification. OBJECTIVE To recommend a novel classification of spinal dumbbell tumors based on the characteristics of surgical approach. SUMMARY OF BACKGROUND DATA Current classifications of cervical dumbbell tumor are excessively convoluted with an impractical number of variables or lack of quantitative indicators for the choice of surgical approach, and there are few classifications described in the literature which related to thoracic or lumbar dumbbell tumors. An ideal classification must be simple and reproducible based on commonly identified clinical and radiographic parameters. METHODS The clinical records of a series of 124 patients with spinal dumbbell tumors were analyzed retrospectively using a new classification. We divided the largest transverse section of the tumor into four areas, and different areas need different surgical procedures. RESULT Ninety-two patients were treated using the posterior approach alone, 13 patients underwent surgery by lateral cervical approach, and 19 cases were excised using combined anterior and posterior approach. Tumors total removal was 123 cases, with partial resection in one patient. Concomitant spinal fixation and fusion was performed in 18 patients. A total of 97 cases had follow-up with clinical and radiographic outcome variables ranged from 12 to 52 months (mean, 46.3 months). Eighty-eight patients (90.7%) had clinical improvement, whereas clinical status was the same in seven (7.2%), two patients (2.1%) demonstrated neurologic deterioration, and magnetic resonance imaging at last follow-up revealed no recurrence in any patient. CONCLUSION The new classification of spinal dumbbell tumors is a simple way of identifying patients who require a different surgical approach. LEVEL OF EVIDENCE 4.
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Yin M, Huang Q, Sun Z, Gao X, Chen G, He S, Xia Y, Ma J, Mo W, Xiao J. An independent evaluation on the interobserver reliability and intraobserver reproducibility of Toyama classification system for cervical dumbbell tumors. Medicine (Baltimore) 2017; 96:e6183. [PMID: 28272207 PMCID: PMC5348155 DOI: 10.1097/md.0000000000006183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/01/2017] [Accepted: 02/01/2017] [Indexed: 11/26/2022] Open
Abstract
Dumbbell tumors can not only cause the compression of cervical cord and nerve root, but also invade the important structures and the surrounding organs, causing great harm to the patient. Toyama classification that is commonly used has not been evaluated and still requires independent validation.The objectives of this study were to evaluate and analyze the interobserver reliability and intraobserver reproducibility of Toyama classification system, explore the differences, discover the shortages, and evaluate the clinical value for diagnosis.One hundred sixty-five consecutive patients of a cervical dumbbell tumor with complete clinical and radiologic data were enrolled. Six surgeons determined the classification according to Toyama system. The classification was repeated 12 weeks later. Correlation coefficient (ICC) and kappa coefficient (κ) test were used to determine interobserver reliability and intraobserver reproducibility.The interobserver reliability for Toyama classification was moderate with a value of 0.432. The interobserver reproducibility for Toyama classification was moderate with a value of 0.608.The Toyama classification has landmark value in clinical practice, but it is a relatively cumbersome system. This study shows that it has low reliability and reproducibility. Accordingly, surgical management of the resection of dumbbell cervical tumors raises several problems, including preservation of the cervical nerve root, control of the vertebral artery, and maintenance of spine. There is a need to optimize the classification in the future.
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Affiliation(s)
- Mengchen Yin
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Quan Huang
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhengwang Sun
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xin Gao
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Guanghui Chen
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Shaohui He
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Ye Xia
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine
| | - Junming Ma
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine
| | - Wen Mo
- Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine
| | - Jianru Xiao
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Ampie L, Choy W, Khanna R, Smith ZA, Dahdaleh NS, Parsa AT, Bloch O. Role of preoperative embolization for intradural spinal hemangioblastomas. J Clin Neurosci 2015; 24:83-7. [PMID: 26585384 DOI: 10.1016/j.jocn.2015.09.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/18/2015] [Indexed: 11/30/2022]
Abstract
Spinal hemangioblastomas (HB) are relatively rare neoplasms with a high degree of vascularity. Therapy for symptomatic tumors involves total resection when possible. Due to the enriched blood supply of these neoplasms, there is a high risk of significant intraoperative blood loss, which can lead to perioperative complications. Preoperative embolization of HB has been suggested to reduce blood loss and operative morbidity, but its use remains controversial. Data on the risks and benefits of preoperative embolization for this tumor remains limited. We identified and analyzed all 29 reported cases of preoperative embolization of intradural spinal HB within the literature. There were 18 men and nine women, and patients ranged from 24 to 61 years of age. Mean tumor size was 3.5 cm. Cervical and thoracic location was most common, accounting for 48.3% and 20% of cases, respectively. Complications from embolization and surgery were minimal, with no deaths or permanent neurological morbidity. Minimal intraoperative bleeding and excellent rates of gross total resection were reported with preoperative embolization. However, outcomes from microsurgery alone from historical series have similarly reported excellent outcomes. While there is no established standard, preoperative embolization should be reserved for particularly high risk patients with risk of intraoperative bleeding.
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Affiliation(s)
- Leonel Ampie
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 2210, Chicago, IL 60611-2911, USA
| | - Winward Choy
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 2210, Chicago, IL 60611-2911, USA
| | - Ryan Khanna
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 2210, Chicago, IL 60611-2911, USA
| | - Zachary A Smith
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 2210, Chicago, IL 60611-2911, USA
| | - Nader S Dahdaleh
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 2210, Chicago, IL 60611-2911, USA
| | - Andrew T Parsa
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 2210, Chicago, IL 60611-2911, USA
| | - Orin Bloch
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 2210, Chicago, IL 60611-2911, USA.
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Ando K, Imagama S, Ito Z, Kobayashi K, Ukai J, Muramoto A, Shinjo R, Matsumoto T, Nakashima H, Nishida Y, Ishiguro N. Unilateral instrumented fixation for cervical dumbbell tumors. J Orthop Surg Res 2014; 9:2. [PMID: 24438086 PMCID: PMC3898569 DOI: 10.1186/1749-799x-9-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 01/13/2014] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The purpose of this study was to describe the radiological outcomes in patients with unilateral instrumented fixation for cervical dumbbell tumors. PATIENTS AND METHODS Fourteen consecutive individuals were included in the present study. We included Eden type II and III tumors in this cohort study and analyzed fixed segment fusion rates, screw failure with multiplanar reconstruction computed tomography (CT) scan radiographs and lateral radiographs with flexion-extension dynamic views, and immediate postoperative and last follow-up radiographs after surgery. RESULTS The mean follow-up was 105.4 months. There were six men and eight women ranging in age from 32 to 70 years (mean age, 48 years). Twenty pedicle screws (PSs) and 11 lateral mass screws (LMSs) were used in total. There were seven patients with only PSs, four with only LMSs, and three with PSs at C2 and LMSs at C3. PS misplacement occurred in three screws of insertions including two screws with grade 1 misplacement and one screw with grade 2 misplacement, and no grade 3 misplacement occurred. All screws breached the lateral wall with no apparent superior or inferior misplacement. None of the LMSs were misplaced. Fortunately, no complication could be directly attributed to screw insertion. Radiological evidence showed that all patients achieved successful fusion with no screw loosening or breakage. However, two patients who received only LMS fixation had degenerative spondylolisthesis at the upper fusion segment at the last follow-up. CONCLUSIONS Grade 2 PS misplacement occurred in one screw of insertions. Unilateral pedicle screw fixation for cervical dumbbell tumors is a useful surgical method that can successfully fuse vertebrae with good postoperative alignment.
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Affiliation(s)
- Kei Ando
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65-Tsurumai, Nagoya City, Aichi 466-8550, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65-Tsurumai, Nagoya City, Aichi 466-8550, Japan
| | - Zenya Ito
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65-Tsurumai, Nagoya City, Aichi 466-8550, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65-Tsurumai, Nagoya City, Aichi 466-8550, Japan
| | - Junichi Ukai
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65-Tsurumai, Nagoya City, Aichi 466-8550, Japan
| | - Akio Muramoto
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65-Tsurumai, Nagoya City, Aichi 466-8550, Japan
| | - Ryuichi Shinjo
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65-Tsurumai, Nagoya City, Aichi 466-8550, Japan
| | - Tomohiro Matsumoto
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65-Tsurumai, Nagoya City, Aichi 466-8550, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65-Tsurumai, Nagoya City, Aichi 466-8550, Japan
| | - Yoshihiro Nishida
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65-Tsurumai, Nagoya City, Aichi 466-8550, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65-Tsurumai, Nagoya City, Aichi 466-8550, Japan
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Nishimura Y, Hara M, Natsume A, Takemoto M, Fukuyama R, Wakabayashi T. Intra-extradural dumbbell-shaped hemangioblastoma manifesting as subarachnoid hemorrhage in the cauda equina. Neurol Med Chir (Tokyo) 2013; 52:659-65. [PMID: 23006882 DOI: 10.2176/nmc.52.659] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 56-year-old man presented with a rare intra-extradural dumbbell-shaped hemangioblastoma in the lumbar spine associated with von Hippel-Lindau (VHL) disease manifesting as subarachnoid hemorrhage. The tumor, which was exiting at the right L2-3 intervertebral foramen, was removed successfully by total facetectomy and posterior spinal fusion at the L2-3 segment. Nine years later, a recurrent tumor due to VHL was also totally removed with minimal neurological complications. Accurate diagnosis of this vascular-rich lesion is essential for developing an adequate surgical strategy. The dumbbell-shaped tumor requires total facetectomy and spinal reconstruction, and care should be taken to preserve the entire nerve root origin by only identifying the affected nerve fascicles at the origin, if possible. Postoperative adhesion must be minimized for second surgery in patients with genetic disease such as VHL, who are likely to suffer recurrence.
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Affiliation(s)
- Yusuke Nishimura
- Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Aichi, Japan.
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13
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Amato MCM, Matias CCMS, Assirati Junior JA, Becker AP, Carlotti Junior CG, Colli BO. Extra and intradural spinal Hemangioblastoma. COLUNA/COLUMNA 2012. [DOI: 10.1590/s1808-18512012000300013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hemangioblastomas of the central nervous system (CNS) are low-grade highly vascularized tumors that may be sporadic or associated with Von Hippel-Lindau disease. Extradural hemangioblastomas are uncommon and those located extra and intradurally are even rarer. This study uses an illustrative case and literature review to discuss the difficulties to consider the correct diagnosis and to select the best surgical approach. A 57 years-old white male patient presented with myelopathy and right C5 radiculopathy. The images showed a lobulated, hourglass shaped, highly enhanced extra/intradural lesion that occupied the spinal canal and widened the C4-C5 right intervertebral foramen. Total resection of the intradural lesion was achieved through a posterior approach, but the extradural part could only be partially removed. Complete improvement was observed after four months of follow-up and the residual tumor has been followed up clinically and radiologically. Even though the preoperative impression was of a spinal schwannoma, the histopathological examination revealed grade I hemangioblastoma as per WHO. Despite their rarity, current complementary exams allow considering the diagnosis of hemangioblastoma preoperatively. That is essential to a better surgical planning in view of the particular surgical features of this lesion.
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14
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Sawyer B, Heng R, Ferris N. Typical magnetic resonance features of a haemangioblastoma, an uncommon nerve root lesion: case report and literature review. ACTA ACUST UNITED AC 2007; 51 Spec No.:B28-30. [PMID: 17875149 DOI: 10.1111/j.1440-1673.2007.01835.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Haemangioblastomas are uncommon tumours of the central nervous system. Nerve root haemangioblastomas with both intradural and extradural components are extremely rare. We present a case of a C2 nerve root haemangioblastoma in a 64-year-old man where the preoperative diagnosis was a spinal meningioma. An unexpectedly vascular tumour was found at initial procedure. Urgent catheter angiography was performed and the tumour was embolized prior to complete excision at a subsequent procedure.
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Affiliation(s)
- B Sawyer
- Department of Radiology, Western Hospital, Footscray, Melbourne, Victoria, Australia.
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15
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Barrey C, Saint-Pierre G, Frappaz D, Hermier M, Mottolese C. Complete removal of an intraspinal and extraspinal cervical chordoma in one stage using the lateral approach. Technical note. J Neurosurg Spine 2006; 5:471-5. [PMID: 17120901 DOI: 10.3171/spi.2006.5.5.471] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors describe a precise surgical technique in which a large intraspinal and extraspinal, multivertebral, cervical chordoma was completely removed in one stage using the lateral approach. The patient in this case was a 29-year-old woman who presented with signs of radicular pain in the left C-3 area. Computed tomography and magnetic resonance imaging demonstrated a large intra- and extraspinal multivertebral tumor from C-2 to C-5, a finding that suggested a cervical chordoma. The tumor was completely removed in one stage using the lateral approach while controlling the vertebral artery (VA), and a partial corporectomy of C2-5 was also performed. Results from a postoperative histopathological examination confirmed that the tumor was a typical chordoma. The patient's postoperative course was uneventful. Cervical chordomas are typically excised using a posterior-anterior surgical approach with partial resection of the tumor. The lateral approach was appropriate in this patient for complete resection in one stage, because it enabled the surgeons to control the VA and access both extraspinal and intraspinal components of the chordoma.
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Affiliation(s)
- Cédric Barrey
- Department of Neurosurgery, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon, France.
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Sid-Ahmed S, Seizeur R, Forlodou P, Dam-Hieu P, Quintin-Roue I, Person H, Besson G. Hémangioblastome « en sablier » de la huitième racine cervicale. Neurochirurgie 2006; 52:533-6. [PMID: 17203902 DOI: 10.1016/s0028-3770(06)71362-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Hemangioblastomas involving cervical nerve roots are extremely rare. Only one case has been previously reported in the literature. We report the case of a 33-year-old man presenting with a 6-month history of upper limb pain. MRI and cervical angiography demonstrated the presence of a dumbell (intra and extradural) and highly vascularized tumor of the right C7-T1 foramina. Histological examination eventually confirmed the diagnosis of hemangioblastoma. Total removal of such a lesion may require combined (anterior and posterior) approaches and preoperative embolization.
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Affiliation(s)
- S Sid-Ahmed
- Service de Neurochirurgie, CHU La Cavale Blanche, boulevard Tanguy-Prigent, 29609 Brest Cedex.
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