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Datta D, Ghosh P, Hazra S, Das S, Pathak D. Intratumoural haemorrhage in intracranial germ cell tumours: A review of literature with an illustrative case. World Neurosurg X 2024; 23:100336. [PMID: 38516025 PMCID: PMC10955666 DOI: 10.1016/j.wnsx.2024.100336] [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] [Received: 05/02/2023] [Accepted: 02/21/2024] [Indexed: 03/23/2024] Open
Affiliation(s)
- Debajyoti Datta
- Department of Neurosurgery, Institute of Neurosciences, Kolkata, India
| | - Partha Ghosh
- Department of Neurosurgery, Institute of Neurosciences, Kolkata, India
| | - Sutirtha Hazra
- Department of Neurosurgery, Institute of Neurosciences, Kolkata, India
| | - Soutrik Das
- Department of Pathology, Institute of Neurosciences, Kolkata, India
| | - Debajyoti Pathak
- Department of Neurosurgery, Institute of Neurosciences, Kolkata, India
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2
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Zander C, Diebold M, Shah MJ, Malzkorn B, Prinz M, Urbach H, Erny D, Taschner CA. Freiburg Neuropathology Case Conference: : 68-Year-Old Patient with Slurred Speech, Double Vision, and Increasing Gait Disturbance. Clin Neuroradiol 2024; 34:279-286. [PMID: 38345610 PMCID: PMC10881640 DOI: 10.1007/s00062-024-01385-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/22/2024]
Affiliation(s)
- C Zander
- Departments of Neuroradiology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
| | - M Diebold
- Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
| | - M J Shah
- Neurosurgery, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
| | - B Malzkorn
- Institute of Neuropathology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - M Prinz
- Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
| | - H Urbach
- Departments of Neuroradiology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
| | - D Erny
- Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
| | - C A Taschner
- Departments of Neuroradiology, University of Freiburg, Freiburg, Germany.
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany.
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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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4
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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.
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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
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Haider AS, McCutcheon IE, Ene CI, Fuller GN, Schomer DF, Gule-Monroe M, DeMonte F, Ferguson SD, Lang FF, Prabhu SS, Raza SM, Suki D, Weinberg JS, Sawaya R. Subependymomas of the fourth ventricle: To operate or not to operate? J Clin Neurosci 2023; 118:147-152. [PMID: 37944358 DOI: 10.1016/j.jocn.2023.10.025] [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: 08/14/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND There is a paucity of literature regarding the clinical characteristics and management of subependymomas of the fourth ventricle due to their rarity. Here, we describe the operative and non-operative management and outcomes of patients with such tumors. METHODS This retrospective single-institution case series was gathered after Institutional Review Board (IRB) approval. Patients diagnosed with a subependymoma of the fourth ventricle between 1993 and 2021 were identified. Clinical, radiology and pathology reports along with magnetic resonance imaging (MRI) images were reviewed. RESULTS Patients identified (n = 20), showed a male predominance (n = 14). They underwent surgery (n = 9) with resection and histopathological confirmation of subependymoma or were followed with imaging surveillance (n = 11). The median age at diagnosis was 51.5 years. Median tumor volume for the operative cohort was 8.64 cm3 and median length of follow-up was 65.8 months. Median tumor volume for the non-operative cohort was 0.96 cm3 and median length of follow-up was 78 months. No tumor recurrence post-resection was noted in the operative group, and no tumor growth from baseline was noted in the non-operative group. Most patients (89 %) in the operative group had symptoms at diagnosis, all of which improved post-resection. No patients were symptomatic in the non-operative group. CONCLUSIONS Surgical resection is safe and is associated with alleviation of presenting symptoms in patients with large tumors. Observation and routine surveillance are warranted for smaller, asymptomatic tumors.
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Affiliation(s)
- Ali S Haider
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
| | - Ian E McCutcheon
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Chibawanye I Ene
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Gregory N Fuller
- Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Donald F Schomer
- Neuroradiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Maria Gule-Monroe
- Neuroradiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Franco DeMonte
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Sherise D Ferguson
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Frederick F Lang
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Sujit S Prabhu
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Shaan M Raza
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Dima Suki
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey S Weinberg
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Raymond Sawaya
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA; Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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Park S, Kwon B, Lee DH, Ahn JS, Song Y. Ruptured Medullary Hemangioblastoma Mimicking a Craniocervical Junction Dural Arteriovenous Fistula with a Pseudoaneurysm. Neurointervention 2023; 18:209-213. [PMID: 37866937 PMCID: PMC10626037 DOI: 10.5469/neuroint.2023.00451] [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: 10/11/2023] [Revised: 10/14/2023] [Accepted: 10/15/2023] [Indexed: 10/24/2023] Open
Abstract
Hemangioblastomas (HBMs) are rare vascular tumors commonly located in the posterior fossa of adults. A mid-50s patient presented with sudden unconsciousness. Computed tomography scans revealed acute hemorrhages around the posterior fossa, predominantly in the subarachnoid space. Digital subtraction angiography (DSA) revealed an 8-mm round lesion filled with contrast agent, fed by the C1 segmental artery of the left vertebral artery (VA), showing early venous drainage to the spinal cord and brainstem. Emergent embolization was attempted under suspicion of a ruptured dural arteriovenous fistula, resulting in parent artery occlusion due to feeder selection failure. Follow-up DSA after a month depicted a persistent aneurysm via collaterals from both VAs. Consequently, the decision was made to proceed with surgical intervention, leading to the resection of the lesion, confirming its diagnosis as a HBM through histological examination. This case underscores the potential for misdiagnosis when HBMs with an intratumoral shunt mimic vascular shunt lesions.
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Affiliation(s)
- Sangil Park
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Boseong Kwon
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Deok Hee Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Sung Ahn
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yunsun Song
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Ghare A, Wong QHW, Sefcikova V, Waraich M, Samandouras G. Handling Severe Intraoperative Hemorrhage and Avoiding Iatrogenic Stroke During Brain Tumor Surgery: Techniques for Prevention of Hemorrhagic and Ischemic Complications. World Neurosurg 2023; 176:e135-e150. [PMID: 37178915 DOI: 10.1016/j.wneu.2023.05.019] [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: 01/03/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Nationwide databases show that iatrogenic stroke and postoperative hematoma are among the commonest complications in brain tumor surgery, with a 10-year incidence of 16.3/1000 and 10.3/1000, respectively. However, techniques for handling severe intraoperative hemorrhage and dissecting, preserving, or selectively obliterating vessels traversing the tumor are sparse in the literature. METHODS Records of the senior author's intraoperative techniques during severe haemorrhage and vessel preservation were reviewed and analyzed. Intraoperative media demonstrations of key techniques were collected and edited. In parallel, a literature search investigating technique description in handling severe intraoperative hemorrhage and vessel preservation in tumor surgery was undertaken. Histologic, anesthetic, and pharmacologic prerequisites of significant hemorrhagic complications and hemostasis were analyzed. RESULTS The senior author's techniques for arterial and venous skeletonization, temporary clipping with cognitive or motor mapping, and ION monitoring were categorized. Vessels interfacing with tumor are labeled intraoperatively as supplying/draining the tumor, or traversing en passant, while supplying/draining functional neural tissue. Intraoperative techniques of differentiation were analyzed and illustrated. Literature search found 2 vascular-related complication domains in tumor surgery: perioperative management of excessively vascular intraparenchymal tumors and lack of intraoperative techniques and decision processes for dissecting and preserving vessels interfacing or traversing tumors. CONCLUSIONS Literature searches showed a dearth of complication-avoidance techniques in tumor-related iatrogenic stroke, despite its high prevalence. A detailed preoperative and intraoperative decision process was provided along with a series of case illustrations and intraoperative videos showing the techniques required to reduce intraoperative stroke and associated morbidity addressing a void in complication avoidance of tumor surgery.
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Affiliation(s)
- Aisha Ghare
- Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Queenie Hoi-Wing Wong
- UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Viktoria Sefcikova
- UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; The University of Queensland Medical School, Brisbane, Queensland, Australia
| | - Manni Waraich
- Department of Neuroanaesthesia, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - George Samandouras
- Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom; UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.
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Saeed Z, Tasleem A, Asthagiri A, Schiff D, Jo J. Fatal Intracranial Hemorrhage With Belzutifan in von Hippel-Lindau Disease-Associated Hemangioblastoma: A Case Report. JCO Precis Oncol 2023; 7:e2300066. [PMID: 37262389 DOI: 10.1200/po.23.00066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/23/2023] [Accepted: 04/11/2023] [Indexed: 06/03/2023] Open
Affiliation(s)
- Zabila Saeed
- Division of Hematology Oncology, Department of Internal Medicine, East Carolina University, Greenville, NC
| | - Azka Tasleem
- Division of Hematology Oncology, Department of Internal Medicine, East Carolina University, Greenville, NC
| | - Ashok Asthagiri
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA
| | - David Schiff
- Division of Neuro-oncology, Department of Neurology, University of Virginia, Charlottesville, VA
| | - Jasmin Jo
- Division of Hematology Oncology, Department of Internal Medicine, East Carolina University, Greenville, NC
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Fallah J, Weinstock C, Mehta GU, Brave MH, Pierce WF, Pazdur R, Nair A, Suzman DL, Amiri-Kordestani L. FDA Approval Summary: Belzutifan for VHL Disease Tumors-Response. Clin Cancer Res 2023; 29:685. [PMID: 36722139 DOI: 10.1158/1078-0432.ccr-22-3428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/08/2022] [Accepted: 11/17/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Jaleh Fallah
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Chana Weinstock
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Gautam U Mehta
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Michael H Brave
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - William F Pierce
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Richard Pazdur
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland.,Oncology Center of Excellence, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Abhilasha Nair
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Daniel L Suzman
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Laleh Amiri-Kordestani
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
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Trinh JQ, Ellithi M, Shonka N, Bergan RC. FDA Approval Summary: Belzutifan for VHL Disease Tumors-Letter. Clin Cancer Res 2023; 29:684. [PMID: 36722140 PMCID: PMC10124993 DOI: 10.1158/1078-0432.ccr-22-2968] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/07/2022] [Accepted: 11/17/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Jonathan Q Trinh
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Moataz Ellithi
- Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska
| | - Nicole Shonka
- Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska
| | - Raymond C Bergan
- Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska
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11
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Ikeuchi Y, Nishihara M, Ashida N, Hosoda K. Von Hippel-Lindau disease with intracranial hemorrhage due to arteriovenous anastomosis via multiple spinal hemangioblastomas: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22375. [PMID: 36572975 PMCID: PMC9795826 DOI: 10.3171/case22375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/10/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Some spinal hemangioblastomas (HBLs) resemble spinal vascular malformations. Intracranial subarachnoid hemorrhage (SAH) secondary to spinal HBL has rarely been reported. OBSERVATIONS A 67-year-old man with a prolonged von Hippel-Lindau disease (VHL) history presented with sudden headache and vomiting. Cranial and cervical computed tomography (CT) revealed severe infratentorial, supratentorial, and cervical SAH. Cranial CT angiography and magnetic resonance imaging revealed a mismatch in hemorrhage and intracranial tumor localization, with no vascular lesions that could lead to intracranial SAH. Cervical CT angiography revealed abnormal blood vessels originating from 5 spinal tumors suspected to be HBLs. We considered that the SAH was caused by venous reflex from vascular malformation-like spinal HBLs. Transarterial embolization (TAE) of the feeding artery of HBLs was performed to improve symptoms and reduce rebleeding risk. Nine months after TAE, angiography showed no venous reflux into the intracranial space. Ten months later, the authors excised the T1-2 tumor because the patient complained of progressive paralysis of the right upper extremity. LESSONS In HBL with prolonged VHL, intracranial hemorrhage due to venous regurgitation via a mimicked vascular malformation may occur. Reducing venous reflux with TAE may improve symptoms and prevent rebleeding.
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Affiliation(s)
- Yusuke Ikeuchi
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Chuo-Ku, Kobe, Japan; and ,Department of Neurosurgery, Nishi-Kobe Medical Center, Kobe, Japan
| | | | - Noriaki Ashida
- Department of Neurosurgery, Nishi-Kobe Medical Center, Kobe, Japan
| | - Kohkichi Hosoda
- Department of Neurosurgery, Nishi-Kobe Medical Center, Kobe, Japan
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12
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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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Oda K, Amamoto T, Enomoto T, Kobayashi H, Morishita T, Iwaasa M, Abe H, Inoue T. Favorable management of symptomatic cerebellar hemangioblastoma presenting with obstructive hydrocephalus during pregnancy: A case report and literature review. Surg Neurol Int 2022; 13:174. [PMID: 35509572 PMCID: PMC9062972 DOI: 10.25259/sni_105_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: 01/25/2022] [Accepted: 04/03/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Cerebellar hemangioblastoma is a highly vascular benign tumor and the growth rate of hemangioblastomas is believed to often accelerate during pregnancy; however, the reason for this rapid increase in size remains poorly understood. There are several case reports of symptomatic hemangioblastoma during pregnancy; however, the favorable management strategy has not been well established. Case Description: A 35-year-old woman, gravida 2 para 1, with no significant medical history presented with vertigo and difficulty walking at around 11 weeks of pregnancy and was referred to our institute at 30 weeks of gestation because of worsening symptoms. Brain magnetic resonance imaging revealed a 5.6 cm cystic lesion with a mural nodule in the right cerebellar hemisphere and the lesion blocked cerebrospinal fluid drainage from the fourth ventricle and brainstem, resulting in obstructive hydrocephalus. After obtaining the patient’s consent, a multidisciplinary team consisting of obstetricians and neurosurgeons decided to perform resection of the intracranial lesion following delivery of the fetus by emergency cesarean section in view of the symptoms of increased intracranial pressure. The patient’s general condition was confirmed to be stable postoperatively and she was discharged on the 16th day of her hospitalization without any neurological deficits or fetal complications. Conclusion: Urgent tumor resection combined with cesarean section can be planned once fetal lung maturity is confirmed. Most cases of symptomatic hemangioblastoma during pregnancy have an uneventful gestational course and a favorable outcome for both mother and child.
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Haider AS, El Ahmadieh TY, Haider M, Hatanpaa KJ, Pinho MC, Mickey BE, Sawaya R, Fuller GN, Schomer DF, Gule-Monroe M. Imaging characteristics of 4th ventricle subependymoma. Neuroradiology 2022; 64:1795-1800. [PMID: 35426054 PMCID: PMC9365749 DOI: 10.1007/s00234-022-02944-7] [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: 12/24/2021] [Accepted: 04/04/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Subependymomas located within the 4th ventricle are rare, and the literature describing imaging characteristics is sparse. Here, we describe the clinical and radiological characteristics of 29 patients with 4th ventricle subependymoma. METHODS This is a retrospective multi-center study performed after Institutional Review Board (IRB) approval. Patients diagnosed with suspected 4th ventricle subependymoma were identified. A review of clinical, radiology, and pathology reports along with magnetic resonance imaging (MRI) images was performed. RESULTS Twenty-nine patients, including 6 females, were identified. Eighteen patients underwent surgery with histopathological confirmation of subependymoma. The median age at diagnosis was 52 years. Median tumor volume for the operative cohort was 9.87 cm3, while for the non-operative cohort, it was 0.96 cm3. Thirteen patients in the operative group exhibited symptoms at diagnosis. For the total cohort, the majority of subependymomas (n = 22) were isointense on T1, hyperintense (n = 22) on T2, and enhanced (n = 24). All tumors were located just below the body of the 4th ventricle, terminating near the level of the obex. Fourteen cases demonstrated extension of tumor into foramen of Magendie or Luschka. CONCLUSION To the best of our knowledge, this is the largest collection of 4th ventricular subependymomas with imaging findings reported to date. All patients in this cohort had tumors originating between the bottom of the body of the 4th ventricle and the obex. This uniform and specific site of origin aids with imaging diagnosis and may infer possible theories of origin.
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Affiliation(s)
- Ali S. Haider
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Tarek Y. El Ahmadieh
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Maryam Haider
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030 USA
| | - Kimmo J. Hatanpaa
- Department of Pathology, The University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Marco C. Pinho
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Bruce E. Mickey
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Raymond Sawaya
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Gregory N. Fuller
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Donald F. Schomer
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030 USA
| | - Maria Gule-Monroe
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA.
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15
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Ostrowski RP, He Z, Pucko EB, Matyja E. Hemorrhage in brain tumor – An unresolved issue. BRAIN HEMORRHAGES 2022. [DOI: 10.1016/j.hest.2022.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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16
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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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17
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Bertolini G, Fratianni A, Messina AL, Epifani E, Fantoni M, Crafa P, Mazzatenta D, Menozzi R, Giombelli E. Spontaneous Subarachnoid Haemorrhage in Spinal Hemangioblastoma: Illustrative Case and Discussion of a Pathophysiological Hypothesis. J Stroke Cerebrovasc Dis 2021; 30:105925. [PMID: 34153593 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105925] [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: 02/02/2021] [Revised: 04/14/2021] [Accepted: 05/25/2021] [Indexed: 11/25/2022] Open
Abstract
Spontaneous non-aneurysmal subarachnoid haemorrhage (naSAH) is an unusual finding that could be burdened by significant mortality and morbidity rates. Rare pathologies and delayed diagnosis could be advocated as responsible of unfavourable outcomes. Herein, we describe an exceedingly rare giant lumbar spinal hemangioblastoma (80 × 23 mm) presenting as an intracranial naSAH. Based on our radiological and clinical findings a pathophysiological hypothesis linking intracranial naSAH to venous hypertension was discussed for the first time even among lumbar spinal tumors. Although rare, unusual causes should be investigated in presence of radiological atypical finding as a prompt evaluation and treatment could be needed.
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Affiliation(s)
- Giacomo Bertolini
- Department of Neurologic Surgery, Azienda Ospedaliero-Universitaria, Parma, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | - Alessia Fratianni
- Department of Neurologic Surgery, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Alberto Luca Messina
- Department of Neurologic Surgery, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Enrico Epifani
- Interventional Neuroradiology Unit, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Matteo Fantoni
- Interventional Neuroradiology Unit, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Pellegrino Crafa
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Diego Mazzatenta
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Roberto Menozzi
- Interventional Neuroradiology Unit, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Ermanno Giombelli
- Department of Neurologic Surgery, Azienda Ospedaliero-Universitaria, Parma, Italy
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18
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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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19
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A rare condition: Spontaneous subarachnoid haemorrhage due to spinal hemangioblastoma: Report of 2 cases and review of the literature. Neurochirurgie 2020; 66:359-364. [DOI: 10.1016/j.neuchi.2020.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/13/2020] [Accepted: 05/24/2020] [Indexed: 11/19/2022]
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20
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Vergauwen E, Steiert C, Krüger MT, Jilg C, Zschiedrich S, Klingler JH, Van Velthoven V, Gläsker S. Cumulative surgical morbidity in patients with multiple cerebellar and medullary hemangioblastomas. Clin Neurol Neurosurg 2020; 197:106111. [PMID: 32758916 DOI: 10.1016/j.clineuro.2020.106111] [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: 05/14/2020] [Revised: 06/22/2020] [Accepted: 07/24/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Patients affected with von Hippel-Lindau disease often develop multiple hemangioblastomas in the cerebellum and spinal cord. Timing of surgical intervention is difficult and depends largely on the anticipated surgical morbidity. However, data regarding surgical outcome after multiple cerebellar and medullary surgeries are scarce. Our objective was to evaluate cumulative surgical morbidity in patients operated on multiple cerebellar and medullary hemangioblastomas and to deduce recommendations for treatment. METHODS We performed a retrospective analysis for a consecutive cohort of von Hippel-Lindau patients with surgical treatment of at least two cerebellar and/or medullary hemangioblastomas. Pre- and postoperative functional grades were reviewed in patients' files and compared by Modified Ranking Scale (cerebellar surgeries) or by Modified McCormick Score (medullary surgeries). RESULTS Thirty-six patients were surgically treated for at least two cerebellar hemangioblastomas (12 patients), at least two medullary hemangioblastomas (19 patients) or at least two hemangioblastomas in both locations (5 patients). Fourthy-eight cerebellar and 80 medullary procedures were performed in total. On average, multiple cerebellar surgeries caused no clinical deterioration, whereas multiple medullary surgeries led to a slight cumulative deterioration of postoperative functional grades. The severity of this deterioration did not correlate to the number of performed medullary surgeries. CONCLUSION Resection of multiple cerebellar hemangioblastomas is not associated with cumulative morbidity. Although there is a certain cumulative surgical morbidity caused by medullary surgeries, its extent does not increase with the number of performed surgeries. Microsurgical removal of asymptomatic tumors with radiographic progression can also be considered for patients with multiple tumors and previous surgeries.
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Affiliation(s)
- Evelynn Vergauwen
- Department of Neurosurgery, Vrije Universiteit Brussel, University Hospital Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium.
| | - Christine Steiert
- Department of Neurosurgery, Freiburg University Medical Center, Breisacherstr. 64, 79106 Freiburg, Germany.
| | - Marie Therese Krüger
- Department of Neurosurgery, Freiburg University Medical Center, Breisacherstr. 64, 79106 Freiburg, Germany.
| | - Cordula Jilg
- Department of Urology, Freiburg University Medical Center, Hugstetter Straße 55, 79106 Freiburg, Germany.
| | - Stefan Zschiedrich
- Faculty of Medicine, University of Freiburg, Freiburg, Germany; Renal Division, Department of Internal Medicine, Bürgerspital Solothurn, Solothurn, Switzerland.
| | - Jan-Helge Klingler
- Department of Neurosurgery, Freiburg University Medical Center, Breisacherstr. 64, 79106 Freiburg, Germany.
| | - Vera Van Velthoven
- Department of Neurosurgery, Vrije Universiteit Brussel, University Hospital Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium; Department of Neurosurgery, Freiburg University Medical Center, Breisacherstr. 64, 79106 Freiburg, Germany.
| | - Sven Gläsker
- Department of Neurosurgery, Vrije Universiteit Brussel, University Hospital Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium; Department of Neurosurgery, Freiburg University Medical Center, Breisacherstr. 64, 79106 Freiburg, Germany; Neurosurgical Practise Lake Constance, Virchowstraße 10, 78224 Singen, Hohentwiel, Germany.
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21
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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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22
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Abboud FZ, Youssoufi MA, Bouhafa T, Hassouni K. A solitary hemangioblastoma of the posterior brain fossa: the role of radiotherapy. Pan Afr Med J 2020; 36:114. [PMID: 32821325 PMCID: PMC7406467 DOI: 10.11604/pamj.2020.36.114.22282] [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: 03/10/2020] [Accepted: 04/30/2020] [Indexed: 11/11/2022] Open
Abstract
We report here the case of a patient admitted for management of posterior fossa cerebral hemangioblastoma. A 16-year-old male patient with a history of intracranial hypertension syndrome consisting of progressively worsening headache, vomiting, especially morning and jet vomiting, and decreased visual acuity. The patient's symptomatology worsened a few days later with the appearance of a disturbance of balance with enlargement of the sustentation polygon. The patient initially benefited from a brain computed tomography (CT) scan that objectified a solidocystic process of the posterior brain fossa. The patient then underwent a surgical excision that was considered partial and the diagnosis of hemangioblastoma was made on the surgical specimen. Since the surgical removal was partial the patient was referred to our training where he received external radiotherapy on his hemangioblastoma of the posterior brain fossa. The patient was examined one month after the end of irradiation; he presented a spectacular improvement in his neurological symptomatology with a clear regression of balance disorders. The standard treatment for cerebellar hemangioblastoma is complete microsurgical removal, but our results show a high level of efficacy for fractional photon radiotherapy after partial surgery of this benign tumour.
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Affiliation(s)
- Fatima Zahra Abboud
- Department of Radiation Oncology, University Hassan II, Hospital of Fez, Fez, Morocco
| | - Moulay Ali Youssoufi
- Medical Physics Unit, Oncology Hospital, University Hospital Hassan II, Fez, Morocco
| | - Touria Bouhafa
- Department of Radiation Oncology, University Hassan II, Hospital of Fez, Fez, Morocco
| | - Khalid Hassouni
- Department of Radiation Oncology, University Hassan II, Hospital of Fez, Fez, Morocco
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23
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Klingler JH, Gläsker S, Bausch B, Urbach H, Krauss T, Jilg CA, Steiert C, Puzik A, Neumann-Haefelin E, Kotsis F, Agostini H, Neumann HPH, Beck J. Hemangioblastoma and von Hippel-Lindau disease: genetic background, spectrum of disease, and neurosurgical treatment. Childs Nerv Syst 2020; 36:2537-2552. [PMID: 32507909 PMCID: PMC7575510 DOI: 10.1007/s00381-020-04712-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/28/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Hemangioblastomas are rare, histologically benign, highly vascularized tumors of the brain, the spinal cord, and the retina, occurring sporadically or associated with the autosomal dominant inherited von Hippel-Lindau (VHL) disease. Children or adults with VHL disease have one of > 300 known germline mutations of the VHL gene located on chromosome 3. They are prone to develop hemangioblastomas, extremely rarely starting at age 6, rarely at age 12-18, and, typically and almost all, as adults. There is a plethora of VHL-associated tumors and cysts, mainly in the kidney, pancreas, adrenals, reproductive organs, and central nervous system. Due to a lack of causal treatment, alleviation of symptoms and prevention of permanent neurological deficits as well as malignant transformation are the main task. Paucity of data and the nonlinear course of tumor progression make management of pediatric VHL patients with hemangioblastomas challenging. METHODS The Freiburg surveillance protocol was developed by combining data from the literature and our experience of examinations of > 300 VHL patients per year at our university VHL center. RESULTS Key recommendations are to start screening of patients at risk by funduscopy with dilated pupils for retinal tumors with admission to school and with MRI of the brain and spinal cord at age 14, then continue biannually until age 18, with emergency MRI in case of neurological symptoms. Indication for surgery remains personalized and should be approved by an experienced VHL board, but we regard neurological symptoms, rapid tumor growth, or critically large tumor/cyst sizes as the key indications to remove hemangioblastomas. Since repeated surgery on hemangioblastomas in VHL patients is not rare, modern neurosurgical techniques should encompass microsurgery, neuronavigation, intraoperative neuromonitoring, fluorescein dye-based intraoperative angiography, intraoperative ultrasound, and minimally invasive approaches, preceded in selected cases by endovascular embolization. Highly specialized neurosurgeons are able to achieve a very low risk of permanent morbidity for the removal of hemangioblastomas from the cerebellum and spinal cord. Small retinal tumors of the peripheral retina can be treated by laser coagulation, larger tumors by cryocoagulation or brachytherapy. CONCLUSION We consider management at experienced VHL centers mandatory and careful surveillance and monitoring of asymptomatic lesions are required to prevent unnecessary operations and minimize morbidity.
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Affiliation(s)
- Jan-Helge Klingler
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany.
| | - Sven Gläsker
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, VUB University, Brussels, Belgium
| | - Birke Bausch
- Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tobias Krauss
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cordula A Jilg
- Department of Urology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christine Steiert
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Alexander Puzik
- Department of Pediatric Hematology and Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elke Neumann-Haefelin
- Department of Medicine IV, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fruzsina Kotsis
- Department of Medicine IV, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hansjürgen Agostini
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hartmut P H Neumann
- Section for Preventive Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
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24
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Kiyofuji S, Graffeo CS, Yokoyama M, Sora S. Intramedullary and intratumoral hemorrhage in spinal hemangioblastoma: Case report and review of literature. Surg Neurol Int 2018; 9:250. [PMID: 30603234 PMCID: PMC6293603 DOI: 10.4103/sni.sni_344_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 10/31/2018] [Indexed: 12/26/2022] Open
Abstract
Background: Intramedullary hemorrhages involving spinal hemangioblastomas are rare. They are frequently associated with devastating neurologic outcomes, despite with emergent surgical intervention. Here, we presented an example of an intramedullary hemorrhage occurring in a spinal hemangioblastoma, where the patient markedly improved with surgery. Additionally, the appropriate literature was reviewed (including intraoperative video). Case Description: A 49-year-old female with a 4-year history of tingling in the left lower extremity presented with vomiting, stepwise worsening of bilateral scapular pain, new upper motor neuron signs, and severe sensory loss bilaterally below C4 on the left and T4 on the right. The magnetic resonance imaging demonstrated a well-circumscribed, uniformly enhancing intramedullary tumor at the C2 level with hyperintensity on the T2 study consistent with acute hemorrhage and cord edema. An urgent C2 laminectomy was performed for gross total tumor resection. Intraoperatively, intramedullary hemorrhage was identified anterior to the tumor mass and was confirmed histopathologically. Postoperatively, the patient had no new sensorimotor deficits and fully recovered within two postoperative months. Conclusions: Patients presenting with acute intramedullary hemorrhage within hemangioblastomas of the spinal cord may demonstrate significant postoperative neurological recovery.
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Affiliation(s)
- Satoshi Kiyofuji
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.,Department of Neurosurgery, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | | | - Munehiro Yokoyama
- Department of Pathology, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Shigeo Sora
- Department of Neurosurgery, Tokyo Metropolitan Police Hospital, Tokyo, Japan
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25
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Giles RH, Gläsker S. The first prospective trial for von Hippel-Lindau disease: pazopanib. Lancet Oncol 2018; 19:1267-1269. [PMID: 30236512 DOI: 10.1016/s1470-2045(18)30533-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 07/12/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Rachel H Giles
- Department of Nephrology and Hypertension, Regenerative Medicine Center, University Medical Center Utrecht, 3584CT Netherlands; Dutch VHL Organization, the Netherlands.
| | - Sven Gläsker
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
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26
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Alshafai N, Maduri R, Shail M, Chirchiglia D, Meyronet D, Signorelli F. Surgical approach for suprasellar hemangioblastomas preserving the pituitary stalk: Review of the literature and report of a further case. Clin Neurol Neurosurg 2018; 168:147-152. [PMID: 29550691 DOI: 10.1016/j.clineuro.2018.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/03/2018] [Accepted: 03/08/2018] [Indexed: 11/30/2022]
Abstract
Hemangioblastomas (HBLs) are challenging vascular tumours with rare suprasellar location Surgery is recommended in patients with visual impairment, endocrine disorders or hydrocephalus. Surgical removal of pituitary stalk HBLs is challenging due to their location and high vascularity. Our narrative review was guided by the question: "what is the more suitable surgical approach to excise a suprasellar HBL?". Pertinent English literature was scrutinized from database inception to October 2016. Eighteen articles matched our selection criteria. Among the surgically treated patients, 4 were treated through a trans-sphenoidal (TS) approach, 13 through a transcranial approach (2 of them after TS failure). Five other cases were treated with radiotherapy (adjuvant in 3 cases) and 9 patients were managed with simple observation and/or medical treatment. We add a case of complete suprasellar HBL resection through an orbito-zygomatic (OZ) craniotomy with extradural anterior clinoidectomy (EAC). To achieve satisfactory oncologic results with acceptable morbidity for symptomatic suprasellar HBLs, complete tumour removal with pituitary stalk sparing should be attempted through an OZ craniotomy with EAC that provides adequate exposure of the tumour, its vascular supply and the adjacent neural structures.
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Affiliation(s)
- Nabeel Alshafai
- Alshafai Neurosurgical Academy (A.N.A.), Toronto, Ontario, Canada
| | - Rodolfo Maduri
- Department of Clinical Neurosciences, Service of Neurosurgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Mrigank Shail
- Xavier University School of Medicine, Aruba, The Netherlands
| | | | - David Meyronet
- Centre de Pathologie et de Neuropathologie Est, Hospices Civils de Lyon, Lyon, France
| | - Francesco Signorelli
- Department of Neurosurgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France; Division of Neurosurgery, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University "Aldo Moro" of Bari, Italy.
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Ju C, Wright CH, Wright J, Duan Y, Bambakidis NC. Subarachnoid Hemorrhage Associated with Intratumoral Aneurysm Rupture within a Posterior Fossa Hemangioblastoma: The Importance of Continued Surveillance for Cerebral Vasospasm. Cureus 2017; 9:e1606. [PMID: 29075584 PMCID: PMC5655161 DOI: 10.7759/cureus.1606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Cerebellar hemangioblastomas are rare tumors of the neuraxis. Only seven cases of hemangioblastoma associated with a cerebral aneurysm have been reported. We report a case of a patient who presented with acute onset headache as a result of subarachnoid hemorrhage (SAH) and hydrocephalus. Radiographic workup revealed a hemangioblastoma with an intratumoral aneurysm. Preoperative cerebral angiography was performed for both embolization as well as characterization of the aneurysm. The patient underwent a suboccipital craniotomy for tumor resection. The patient’s postoperative course was unexpectedly complicated by delayed ischemic neurologic deficit secondary to flow-limiting left internal carotid artery vasospasm. We present a case report, review of the literature, and management considerations for patients who present with tumors and an associated ruptured aneurysm.
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Affiliation(s)
- Connie Ju
- Neurological Institute, Case Western School of Medicine
| | | | - James Wright
- Neurological Institute, University Hospitals Cleveland Medical Center
| | - Yifei Duan
- Neurological Insitute, University Hospitals Cleveland Medical Center
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Panero I, Eiriz C, Lagares A, Toldos O, Panero A, Paredes I. Intradural-Extramedullary Capillary Hemangioma with Acute Bleeding: Case Report and Literature Review. World Neurosurg 2017; 108:988.e7-988.e14. [PMID: 28823662 DOI: 10.1016/j.wneu.2017.08.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/03/2017] [Accepted: 08/04/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Capillary hemangiomas are benign vascular tumors. They are commonly founded in the vertebral bodies but very seldom in the spinal cord. The most common symptom at onset is long-lasting axial pain without neurologic deficit. In rare cases, the onset may be acute with neurological deficit due to an intratumoral hemorrhage. PATIENT AND METHODS We report a case of a 58-year-old male with a history of 15 days upper back pain triggered by a mild traumatism that evolves acutely to paraplegia and urinary and fecal retention. An urgent MR showed an intradural lesion with signs of intratumoral haemorrhage. RESULTS Urgent surgical intervention was performed and the anatomopathological results were capillary hemangioma. The symptoms of the patient improved after the surgery. CONCLUSIONS Intradural capillary hemangioma with acute intratumoral hemorrhage is a rare pathology, but it must be kept in mind because early diagnosis and treatment are key to achieve a good outcome. As far as we know, this is the first case reported of an intradural-extramedular capillary hemangioma that presents sudden neurologic deficit due to intratumoral bleeding.
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Affiliation(s)
- Irene Panero
- Department of Neurosurgery, 12 de Octubre University Hospital, Madrid, Spain.
| | - Carla Eiriz
- Department of Neurosurgery, 12 de Octubre University Hospital, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, 12 de Octubre University Hospital, Madrid, Spain
| | - Oscar Toldos
- Department of Neuropathology, 12 de Octubre University Hospital, Madrid, Spain
| | | | - Igor Paredes
- Department of Neurosurgery, 12 de Octubre University Hospital, Madrid, Spain
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Subarachnoid Hemorrhage after Surgery of the Medulla Oblongata Hemangioblastoma: A Case Report. TRANSLATIONAL NEUROSCIENCE AND CLINICS 2016. [DOI: 10.18679/cn11-6030_r.2016.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objectives To discuss the bleeding mechanisms after removing a medulla oblongata hemangioblastoma. Methods A 42-year-old male patient was diagnosed with a medulla oblongata hemangioblastoma. Preoperative cranial magnetic resonance imaging, computed tomography angiography and post-surgery computed tomography were completed during clinical procedure. We also reviewed the related literatures. Results The preoperative computed tomography angiography did not demonstrate any intracranial aneurysm. But, the patient had a fatal subarachnoid hemorrhage with ventricular hemorrhage 4 hours after surgery following the post-surgery computed tomography. Conclusions Subarachnoid hemorrhage after surgery of the medulla oblongata hemangioblastoma is very rare. Delayed postoperative hemorrhage seems the most reasonable explanation of Subarachnoid hemorrhage in our case.
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30
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Silva D, Grabowski MM, Juthani R, Sharma M, Angelov L, Vogelbaum MA, Chao S, Suh J, Mohammadi A, Barnett GH. Gamma Knife radiosurgery for intracranial hemangioblastoma. J Clin Neurosci 2016; 31:147-51. [PMID: 27422585 DOI: 10.1016/j.jocn.2016.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/08/2016] [Indexed: 11/25/2022]
Abstract
Gamma knife radiosurgery (GKRS) has become a treatment option for intracranial hemangioblastomas, especially in patients with poor clinical status and also high-risk surgical candidates. The objective of this study was to analyze clinical outcome and tumor control rates. Retrospective chart review revealed 12 patients with a total of 20 intracranial hemangioblastomas treated with GKRS from May 1998 until December 2014. Kaplan-Meier plots were used to calculate the actuarial local tumor control rates and rate of recurrence following GKRS. Univariate analysis, including log rank test and Wilcoxon test were used on the Kaplan-Meier plots to evaluate the predictors of tumor progression. Two-tailed p value of <0.05 was considered as significant. Median follow-up was 64months (2-184). Median tumor volume pre-GKRS was 946mm(3) (79-15970), while median tumor volume post-GKRS was 356mm(3) (30-5404). Complications were seen in two patients. Tumor control rates were 100% at 1year, 90% at 3years, and 85% at 5years, using the Kaplan-Meier method. There were no statistically significant univariate predictors of progression identified, although there was a trend towards successful tumor control in solid tumors (p=0.07). GKRS is an effective and safe option for treating intracranial hemangioblastoma with favorable tumor control rates.
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Affiliation(s)
- Danilo Silva
- Rose Ella Burkhardt Brain Tumor Center, Department of Neurosurgery and Radiation Oncology, Neurological Institute, Cleveland Clinic, OH 44124, USA.
| | - Mathew M Grabowski
- Rose Ella Burkhardt Brain Tumor Center, Department of Neurosurgery and Radiation Oncology, Neurological Institute, Cleveland Clinic, OH 44124, USA
| | - Rupa Juthani
- Rose Ella Burkhardt Brain Tumor Center, Department of Neurosurgery and Radiation Oncology, Neurological Institute, Cleveland Clinic, OH 44124, USA
| | - Mayur Sharma
- Rose Ella Burkhardt Brain Tumor Center, Department of Neurosurgery and Radiation Oncology, Neurological Institute, Cleveland Clinic, OH 44124, USA
| | - Lilyana Angelov
- Rose Ella Burkhardt Brain Tumor Center, Department of Neurosurgery and Radiation Oncology, Neurological Institute, Cleveland Clinic, OH 44124, USA
| | - Michael A Vogelbaum
- Rose Ella Burkhardt Brain Tumor Center, Department of Neurosurgery and Radiation Oncology, Neurological Institute, Cleveland Clinic, OH 44124, USA
| | - Samuel Chao
- Rose Ella Burkhardt Brain Tumor Center, Department of Neurosurgery and Radiation Oncology, Neurological Institute, Cleveland Clinic, OH 44124, USA
| | - John Suh
- Rose Ella Burkhardt Brain Tumor Center, Department of Neurosurgery and Radiation Oncology, Neurological Institute, Cleveland Clinic, OH 44124, USA
| | - Alireza Mohammadi
- Rose Ella Burkhardt Brain Tumor Center, Department of Neurosurgery and Radiation Oncology, Neurological Institute, Cleveland Clinic, OH 44124, USA
| | - Gene H Barnett
- Rose Ella Burkhardt Brain Tumor Center, Department of Neurosurgery and Radiation Oncology, Neurological Institute, Cleveland Clinic, OH 44124, USA
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31
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Lü J, Quan Y, Xu G, Gong SP. Coexistence of intracranial aneurysm and hemangioblastoma: A case report and literature review. Neurochirurgie 2016; 62:229-31. [PMID: 27339833 DOI: 10.1016/j.neuchi.2015.11.003] [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: 04/09/2015] [Revised: 11/01/2015] [Accepted: 11/22/2015] [Indexed: 11/26/2022]
Abstract
The association of intracranial aneurysm and hemangioblastoma is extremely rare. This report regards a patient affected by Von Hippel-Lindau syndrome with multiple hemangioblastoma and two intracranial aneurysms, of which one was on a hemangioblastoma feeder vessel and the other on an unrelated vessel. Review of the literature revealed 13 other previously reported cases. Possible mechanisms to explain the association are discussed.
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Affiliation(s)
- J Lü
- Neurosurgical department, Second Affiliated Hospital, Xi'an Jiaotong university, 710004 Xi'an, China.
| | - Y Quan
- Neurosurgical department, Second Affiliated Hospital, Xi'an Jiaotong university, 710004 Xi'an, China
| | - G Xu
- Neurosurgical department, Second Affiliated Hospital, Xi'an Jiaotong university, 710004 Xi'an, China
| | - S-P Gong
- Neurosurgical department, Second Affiliated Hospital, Xi'an Jiaotong university, 710004 Xi'an, China
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Sahgal A, Chou D, Ames C, Ma L, Lamborn K, Huang K, Chuang C, Aiken A, Petti P, Weinstein P, Larson D. Image-Guided Robotic Stereotactic Body Radiotherapy for Benign Spinal Tumors: The University of California San Francisco Preliminary Experience. Technol Cancer Res Treat 2016; 6:595-604. [DOI: 10.1177/153303460700600602] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We evaluate our preliminary experience using the Cyberknife® Radiosurgery System in treating benign spinal tumors. A retrospective review of 16 consecutively treated patients, comprising 19 benign spinal tumors, was performed. Histologic types included neurofibroma [11], chordoma [4], hemangioma [2], and meningioma [2]. Three patients had Neurofibromatosis Type 1 (NF1). Only one tumor, recurrent chordoma, had been previously irradiated, and as such not considered in the local failure analysis. Local failure, for the remaining 18 tumors, was based clinically on symptom progression and/or tumor enlargement based on imaging. Indications for spine stereotactic body radiotherapy (SBRT) consisted of either adjuvant to subtotal resection (5/19), primary treatment alone (12/19), boost following external beam radiotherapy (1/19), and salvage following previous radiation (1/19). Median tumor follow-up is 25 months (2–37), and one patient (with NF1) died at 12 months from a stroke. The median total dose, number of fractions, and prescription isodose was 21 Gy (10–30 Gy), 3 fx (1–5 fx), 80% (42–87%). The median tumor volume was 7.6 cc (0.2–274.1 cc). The median V100 (volume V receiving 100% of the prescribed dose) and maximum tumor dose was 95% (77–100%) and 26.7 Gy (15.4–59.7 Gy), respectively. Three tumors progressed at 2, 4, and 36 months post-SR (n=18). Two tumors were neurofibromas (both in NF1 patients), and the third was an intramedullary hemangioblastoma. Based on imaging, two tumors had MRI documented progression, three had regressed, and 13 were unchanged (n=18). With short follow-up, local control following Cyberknife spine SBRT for benign spinal tumors appear acceptable.
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Affiliation(s)
- Arjun Sahgal
- Department of Radiation Oncology University of California San Francisco 505 Parnassus Avenue San Francisco, CA 94143, USA
| | - Dean Chou
- Department of Neurologic Surgery University of California San Francisco 505 Parnassus Avenue San Francisco, CA 94143, USA
| | - Christopher Ames
- Department of Neurologic Surgery University of California San Francisco 505 Parnassus Avenue San Francisco, CA 94143, USA
| | - Lijun Ma
- Department of Radiation Oncology University of California San Francisco 505 Parnassus Avenue San Francisco, CA 94143, USA
| | - Kathleen Lamborn
- Department of Epidemiology University of California San Francisco 505 Parnassus Avenue San Francisco, CA 94143, USA
| | - Kim Huang
- Department of Radiation Oncology University of California San Francisco 505 Parnassus Avenue San Francisco, CA 94143, USA
| | - Cynthia Chuang
- Department of Radiation Oncology University of California San Francisco 505 Parnassus Avenue San Francisco, CA 94143, USA
| | - Ashley Aiken
- Department of Radiology University of California San Francisco 505 Parnassus Avenue San Francisco, CA 94143, USA
| | - Paula Petti
- Department of Radiation Oncology University of California San Francisco 505 Parnassus Avenue San Francisco, CA 94143, USA
| | - Phil Weinstein
- Department of Neurologic Surgery University of California San Francisco 505 Parnassus Avenue San Francisco, CA 94143, USA
| | - David Larson
- Department of Radiation Oncology University of California San Francisco 505 Parnassus Avenue San Francisco, CA 94143, USA
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Mariniello G, Malacario F, Dones F, Severino R, Ugga L, Russo C, Elefante A, Maiuri F. Sudden post-traumatic sciatica caused by a thoracic spinal meningioma. Neuroradiol J 2016; 29:390-2. [PMID: 27316567 DOI: 10.1177/1971400916655479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Spinal meningiomas usually present with slowly progressive symptoms of cord and root compression, while a sudden clinical onset is very rare. A 35-year-old previously symptom-free woman presented sudden right sciatica and weakness of her right leg following a fall with impact to her left foot. A neurological examination showed paresis of the right quadriceps, tibial and sural muscles, increased bilateral knee and ankle reflexes and positive Babinski sign. Magnetic resonance imaging (MRI) revealed the presence of a spinal T11 meningioma in the left postero-lateral compartment of the spinal canal; at this level, the spinal cord was displaced to the contralateral side with the conus in the normal position. At surgery, a meningioma with dural attachment of the left postero-lateral dural surface was removed. The intervention resulted in rapid remission of both pain and neurological deficits. Spinal meningiomas may exceptionally present with sudden pain and neurological deficits as result of tumour bleeding or post-traumatic injury of the already compressed nervous structures, both in normal patients and in those with conus displacement or tethered cord. In this case, the traumatic impact of the left foot was transmitted to the spine, resulting in stretching of the already compressed cord and of the contralateral lombosacral roots. This case suggests that low thoracic cord compression should be suspected in patients with post-traumatic radicular leg pain with normal lumbar spine MRI.
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Affiliation(s)
- Giuseppe Mariniello
- Department of Neurosciences and Reproductive and Odontostomatologic Sciences, Neurosurgical Clinic, 'Federico II' University, Naples, Italy
| | - Francesca Malacario
- Department of Advanced Biomedical Sciences, 'Federico II' University, Naples, Italy
| | - Flavia Dones
- Department of Neurosciences and Reproductive and Odontostomatologic Sciences, Neurosurgical Clinic, 'Federico II' University, Naples, Italy
| | - Rocco Severino
- Department of Neurosciences and Reproductive and Odontostomatologic Sciences, Neurosurgical Clinic, 'Federico II' University, Naples, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, 'Federico II' University, Naples, Italy
| | - Camilla Russo
- Department of Advanced Biomedical Sciences, 'Federico II' University, Naples, Italy
| | - Andrea Elefante
- Department of Advanced Biomedical Sciences, 'Federico II' University, Naples, Italy
| | - Francesco Maiuri
- Department of Neurosciences and Reproductive and Odontostomatologic Sciences, Neurosurgical Clinic, 'Federico II' University, Naples, Italy
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Messerer M, Cossu G, Pralong E, Daniel RT. Intramedullary hemangioblastoma: Microsurgical resection technique. Neurochirurgie 2016; 63:376-380. [PMID: 26776665 DOI: 10.1016/j.neuchi.2015.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 11/15/2015] [Accepted: 11/17/2015] [Indexed: 11/25/2022]
Abstract
Spinal hemangioblastomas are benign and highly vascular tumors accounting for 1-5% of intramedullary spinal tumors in surgical series. Surgery is curative in sporadic cases. We present the description of a surgical technique to safely resect an intramedullary hemangioblastoma. A dorsal midline myelotomy provides an excellent exposure of the tumor and identification of the feeding arteries. Interruption of these arteries and precise dissection of the tumor from the cord tissue followed by division of the venous drainage allow the in toto excision of the tumor. Closure of the dorsal myelotomy may be achieved with sequential fusion of the pial and arachnoid edges using a "welding" technique.
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Affiliation(s)
- M Messerer
- Section of Neurosurgery, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland; Section of Neurosurgery, Kremlin-Bicêtre Hospital, University of Paris Sud, 94270 Paris, France
| | - G Cossu
- Section of Neurosurgery, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland.
| | - E Pralong
- Section of Neurosurgery, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - R T Daniel
- Section of Neurosurgery, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
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Ene CI, Morton RP, Ferreira M, Sekhar LN, Kim LJ. Spontaneous Hemorrhage from Central Nervous System Hemangioblastomas. World Neurosurg 2015; 83:1180.e13-7. [DOI: 10.1016/j.wneu.2015.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 01/29/2015] [Accepted: 02/02/2015] [Indexed: 12/12/2022]
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Ma D, Wang Y, Du G, Zhou L. Neurosurgical Management of Brainstem Hemangioblastomas: A Single-Institution Experience with 116 Patients. World Neurosurg 2015; 84:1030-8. [PMID: 26026629 DOI: 10.1016/j.wneu.2015.05.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 05/06/2015] [Accepted: 05/07/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Brainstem hemangioblastomas (HBs) are considered one of the most challenging lesions in surgical procedures. We present our institutional experience with 116 patients over a period of 20 years in the treatment of HBs. METHODS We evaluated the results of microsurgical treatment and highlighted the management strategies. There were 60 male and 56 female patients including 13 cases with clinical evidence of von Hippel-Lindau disease. Tumors were solid in 99 cases and cystic in 17 cases. Tumors were small (≤2 cm) in 43 cases, large (2-4 cm) in 45 cases, and giant (≥4 cm) in 28 cases. RESULTS Radical removal was achieved in 111 patients (95.7%), and incomplete removal was achieved in 5 cases (4.3%). The immediate postoperative mortality and morbidity were 7.8% and 17.2%, respectively. Detailed analyses of outcomes showed that surgical complications were related to some tumor characteristics. Follow-up study was available in 83 patients by Karnofsky performance scale scores. Most patients maintained their preoperative neurologic status. There were 17 patients with surgical disability who demonstrated a clear improvement with rehabilitation treatment. Worsening of neurologic deficits occurred in 2 patients. Ectopic recurrent lesions developed in 2 patients. CONCLUSIONS Based on our experience, microsurgery is safe and effective, and excellent outcomes can be obtained for cystic or small tumors. We advocate early surgical intervention for sporadic HBs; giant solid HBs remain a challenge, and meticulous microsurgical technique and perioperative management are vital. Long-term monitoring also is recommended.
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Affiliation(s)
- Dexuan Ma
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ying Wang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Guhong Du
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Liangfu Zhou
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
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37
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Wang Z, Hu J, Xu L, Malaguit J, Chen S. Intratumoral hemorrhage in a patient with cerebellar hemangioblastoma: a case report and review. Medicine (Baltimore) 2015; 94:e497. [PMID: 25634201 PMCID: PMC4602942 DOI: 10.1097/md.0000000000000497] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Spontaneous hemorrhage is rarely associated with hemangioblastomas. Intratumoral hemorrhage occurring in cerebellar hemangioblastomas is more rare. A 25-year-old man was admitted to our hospital with headache. We found a round cystic lesion with solid part in the right cerebellum. The lesion was resected. The final pathological diagnosis was hemangioblastomas. The radiological features of this case were similar to normal hemangioblastomas, whereas our histological examination showed the occurrence of the intratumoral hemorrhage. If the hemangioblastoma ruptures in our case, the outcome of the patient will be worse. It is difficult to identify the intratumoral hemorrhage of hemangioblastomas and quite dangerous if it is diagnosed late. Diagnosing an intratumoral hemorrhage of hemangioblastomas still needs a further discussion. Genetic screening may help us make an early diagnosis. Furthermore, the mechanism about intratumoral hemorrhage of hemangioblastomas remains unknown. The mutation of D6Mit135 gene on chromosome 6 may be responsible for the vascular dilation and hemorrhage induction in the hemangioblastomas. Tumor size, upregulation of vascular endothelial growth factor, spinalradicular location, and solid type are also factors relating to the hemorrhage of hemangioblastomas. The purpose of reporting our case is 2-fold: to remind clinicians to consider the possibility of internal hemorrhaging while diagnosing this disease, and provide a starting point to discuss mechanisms regarding the intratumoral hemorrhage of hemangioblastomas.
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Affiliation(s)
- Zhen Wang
- From the Department of Neurosurgery (ZW, JH, LX, SC), Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; and Department of Physiology and Pharmacology (JM), Loma Linda University, Loma Linda, CA, USA
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Suzuki M, Umeoka K, Kominami S, Morita A. Successful treatment of a ruptured flow-related aneurysm in a patient with hemangioblastoma: Case report and review of literature. Surg Neurol Int 2014; 5:S430-3. [PMID: 25324977 PMCID: PMC4199150 DOI: 10.4103/2152-7806.141887] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 07/29/2014] [Indexed: 11/30/2022] Open
Abstract
Background: No cerebral aneurysms on the feeder associated with hemangioblastomas that ruptured before resection have been reported. We report a patient with a ruptured flow-related aneurysm associated with cerebellar hemangioblastoma and a tumor feeder treated simultaneously by a single procedure of embolization using N-butyl cyanoacrylate before tumor removal. Case Description: A 36-year-old female with a cerebellar tumor was admitted to our institute. Four days later, she suffered a massive subarachnoid hemorrhage mainly in the posterior fossa. Left vertebral angiograms showed an aneurysm on the feeding artery, posterior inferior cerebellar artery. Both the aneurysm and its main feeder were simultaneously treated by a single procedure of embolization using N-butyl cyanoacrylate. Their complete obliteration was confirmed angiographically. Four days after the procedure, we removed the tumor and the embolized aneurysm. The pathological diagnosis was hemangioblastoma and flow-related ruptured aneurysm. Conclusion: Cerebral angiography should be performed to rule out vascular abnormalities such as cerebral aneurysms adjacent to the tumor in patients with hemangioblastoma who present with intracranial hemorrhage. We emphasize the usefulness of embolization with N-butyl cyanoacrylate for hemangioblastoma with ruptured feeder aneurysm, by which the aneurysm and the feeder could be simultaneously embolized.
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Affiliation(s)
- Masanori Suzuki
- Department of Neurosurgery, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, Japan
| | - Katsuya Umeoka
- Department of Neurosurgery, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, Japan
| | - Shushi Kominami
- Department of Neurosurgery, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, Japan
| | - Akio Morita
- Department of Neurosurgery, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyoku, Tokyo, Japan
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Bründl E, Schödel P, Ullrich OW, Brawanski A, Schebesch KM. Surgical resection of sporadic and hereditary hemangioblastoma: Our 10-year experience and a literature review. Surg Neurol Int 2014; 5:138. [PMID: 25317353 PMCID: PMC4192902 DOI: 10.4103/2152-7806.141469] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 07/30/2014] [Indexed: 11/07/2022] Open
Abstract
Background: Hemangioblastomas (HBLs) are benign neoplasms that contribute to 1-2.5% of intracranial tumors and 7-12% of posterior fossa lesions in adult patients. HBLs either evolve hereditarily in association with von Hippel–Lindau disease (vHL) or, more prevalently, as solitary sporadic tumors. Only few authors have reported on the clinical presentation and the neurological outcome of HBL. Methods: We retrospectively analyzed the clinical, radiological, surgical, and histopathologic records of 24 consecutive patients (11 men, 13 women; mean age 51.3 years) with HBL of the posterior cranial fossa, who had been treated at our center between 2001 and 2012. We reviewed the current literature, and discussed our findings in the context of previous publications on HBL. The study protocol was approved by the local ethics committee (14-101-0070). Results: Mean time to diagnosis was 14 weeks. The extent of resection (EOR) was total in 20 and near total in 4 patients. Four patients required revision within 24 h because of relevant postoperative bleeding. One patient died within 14 days. One patient required permanent shunting. At discharge, 75% of patients [n = 18, modified Rankin scale (mRS) 0-1] showed no or at least resolved symptoms. Mean follow-up was 21 months. Two recurrences were detected during follow-up. Conclusions: In comparison to other benign entities of the posterior fossa, time to diagnosis was significantly shorter for HBL. This finding indicates the rather aggressive biological behavior of these excessively vascularized tumors. In our series, however, the rate of complete resection was high, and morbidity and mortality rates were within the reported range.
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Affiliation(s)
- Elisabeth Bründl
- Department of Neurosurgery, University Medical Center Regensburg, Germany
| | - Petra Schödel
- Department of Neurosurgery, University Medical Center Regensburg, Germany
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Taschner CA, Staszewski O, Weyerbrock A, Urbach H, Egger K, Prinz M. Freiburg neuropathology case conference: tumor of the cerebellum with mild, gyriform enhancement in a 19-year-old patient. Clin Neuroradiol 2014; 24:301-6. [PMID: 25081236 DOI: 10.1007/s00062-014-0325-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C A Taschner
- Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany,
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41
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Direct transcranial puncture for Onyx embolization of a cerebellar hemangioblastoma. J Clin Neurosci 2014; 21:1040-3. [DOI: 10.1016/j.jocn.2013.08.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 08/20/2013] [Indexed: 11/23/2022]
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Gekka M, Yamaguchi S, Kazumata K, Kobayashi H, Motegi H, Terasaka S, Houkin K. Hemorrhagic onset of hemangioblastoma located in the dorsal medulla oblongata presenting with tako-tsubo cardiomyopathy and neurogenic pulmonary edema: a case report. Case Rep Neurol 2014; 6:68-73. [PMID: 24803905 PMCID: PMC4000297 DOI: 10.1159/000361041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Here, we present a case of dorsal medulla oblongata hemangioblastoma with fourth ventricular hemorrhage. A 23-year-old female developed sudden consciousness disturbance, and CT revealed hemorrhage in all cerebral ventricles and a hyperdense mass in the cisterna magna. Although the reddish tumor located in the dorsal medulla oblongata was successfully removed, she suffered from severe tako-tsubo cardiomyopathy (TTC) and neurogenic pulmonary edema (NPE) because of baroreflex failure and damage to the solitary tract nuclei. After intensive care for 12 weeks following surgery, she was discharged without any neurological or radiological deficits. Pathogenesis of TTC/NPE is discussed in this paper.
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Affiliation(s)
- Masayuki Gekka
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shigeru Yamaguchi
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ken Kazumata
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroyuki Kobayashi
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroaki Motegi
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shunsuke Terasaka
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kiyohiro Houkin
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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A solitary hemangioblastoma located on the trochlear nerve. J Clin Neurosci 2014; 21:333-5. [DOI: 10.1016/j.jocn.2013.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 01/13/2013] [Indexed: 11/18/2022]
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Pathological and Clinical Features and Management of Central Nervous System Hemangioblastomas in von Hippel-Lindau Disease. J Kidney Cancer VHL 2014; 1:46-55. [PMID: 28326249 PMCID: PMC5345529 DOI: 10.15586/jkcvhl.2014.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 07/31/2014] [Indexed: 11/18/2022] Open
Abstract
Central nervous system (CNS) hemangioblastoma is the most common manifestation of von Hippel-Lindau (VHL) disease. It is found in 70-80% of VHL patients. Hemangioblastoma is a rare form of benign vascular tumor of the CNS, accounting for 2.0% of CNS tumors. It can occur sporadically or as a familial syndrome. CNS hemangioblastomas are typically located in the posterior fossa and the spinal cord. VHL patients usually develop a CNS hemangioblastoma at an early age. Therefore, they require a special routine for diagnosis, treatment and follow-up. The surgical management of symptomatic tumors depend on many factors such as symptom, location, multiplicity, and progression of the tumor. The management of asymptomatic tumors in VHL patients are controversial since CNS hemangioblastomas grow with intermittent quiescent and rapid-growth phases. Preoperative embolization of large solid hemangioblastomas prevents perioperative hemorrhage but is not necessary in every case. Radiotherapy should be reserved for inoperable tumors. Because of complexities of VHL, a better understanding of the pathological and clinical features of hemangioblastoma in VHL is essential for its proper management.
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Sakamoto N, Ishikawa E, Nakai Y, Akutsu H, Yamamoto T, Nakai K, Shiigai M, Tsurushima H, Isobe T, Takano S, Tsuboi K, Matsumura A. Preoperative endovascular embolization for hemangioblastoma in the posterior fossa. Neurol Med Chir (Tokyo) 2013; 52:878-84. [PMID: 23269042 DOI: 10.2176/nmc.52.878] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Intracranial hemangioblastomas (HBs) are hypervascular neoplasms mainly located in the posterior fossa of the central nervous system. Preoperative embolization of the feeding arteries is one proposal for reduction of intraoperative hemorrhage, although indications for the procedures should be evaluated carefully due to the potential complications. This retrospective study investigated clinical outcomes and complications of 15 patients with HBs in the posterior fossa to evaluate the safety and effectiveness of endovascular procedures as well as angiographical procedures. Surgical excision without presurgical embolization was performed in 8 cases, and excision with presurgical embolization was performed in 7 cases, using Guglielmi detachable coils with or without polyvinyl alcohol (GDC ± PVA) in 4 cases and only n-butyl 2-cyanoacrylate (NBCA) in 3 cases. The embolization was applied for selected cases in which feeding arteries were located in a deep site and hard to coagulate surgically. Partial embolization was achieved in 5 cases, and all feeders were successfully embolized in 2 cases. Total removal was achieved in 12 cases, and subtotal/partial removal was achieved in 3 cases. Subarachnoid hemorrhage with intratumoral hemorrhage occurred in 1 case during the angiographic procedure and in 1 case during the embolization procedures. The mean volume of intraoperative blood loss was clearly less in the NBCA group than in the GDC ± PVA group. HBs are mainly located in the posterior cranial fossa, so the risk of severe clinical complication may be high if vascular problems occur. In our series, presurgical embolization using NBCA made tumor removal safe and reduced bleeding volume in posterior fossa HBs.
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Affiliation(s)
- Noriaki Sakamoto
- Department of Neurosurgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki
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Iihoshi S, Miyata K, Murakami T, Kaneko T, Koyanagi I. Dissection aneurysm of the radiculomedullary branch of the artery of Adamkiewicz with subarachnoid hemorrhage. Neurol Med Chir (Tokyo) 2013; 51:649-52. [PMID: 21946730 DOI: 10.2176/nmc.51.649] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 60-year-old female presented with sudden onset of severe headache and back pain, followed by nausea. The initial head computed tomography (CT) scan revealed posterior fossa subarachnoid hemorrhage (SAH). Spinal T(2)-weighted magnetic resonance imaging demonstrated SAH, and a homogeneous and slightly low signal intensity mass at T11. Spinal angiography in the early arterial phase revealed a small pearl and string-like aneurysm of the proximal radiculomedullary artery on the left side at the T12 level. Forty days after the onset of SAH, CT angiography demonstrated complete occlusion of the dissecting aneurysm and the preserved anterior spinal artery. The present case of ruptured dissecting aneurysm of the radiculomedullary branch of the artery of Adamkiewicz with SAH underwent subsequent spontaneous occlusion, indicating that the wait-and-see strategy may be justified and will provide adequate treatment.
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Affiliation(s)
- Satoshi Iihoshi
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
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Le Reste PJ, Henaux PL, Morandi X, Carsin-Nicol B, Brassier G, Riffaud L. Sporadic intracranial haemangioblastomas: surgical outcome in a single institution series. Acta Neurochir (Wien) 2013; 155:1003-9; discussion 1009. [PMID: 23558723 DOI: 10.1007/s00701-013-1681-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 03/14/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Haemangioblastomas are benign vascular tumours that may appear sporadically or in von Hippel-Lindau disease. Despite their higher incidence, sporadic haemangioblastomas have been less studied than syndromic ones. In this article, we evaluate the specific features, outcome and quality of life of patients with intracranial sporadic haemangioblastomas (ISHs) operated on in our institution. METHODS Between 1998 and 2010, 38 patients harbouring 38 ISHs were operated on in our department. Their clinical, biological, radiological and surgical features were retrospectively reviewed. All patients were contacted for a quality-of-life (QOL) survey assessed by the Short Form 36 questionnaire (SF36). The mean duration of follow-up was 40 months (13-108 months). RESULTS ISH represented 0.9 % of primary intracranial neoplasms treated in our centre during this period. Patients comprised 23 men and 15 women with a mean age of 47 years. None had polycythaemia. Cerebellar locations accounted for 79 % of ISHs, and brainstem ISH with involvement of the floor of the fourth ventricle represented 11 % of ISHs. At last follow-up, two patients harbouring solid medulla oblongata haemangioblastoma had died following severe bulbar syndrome and five patients had died of unrelated causes. One patient had multiple surgeries for three recurrences. Tumoral control was achieved in all cases at last follow-up. Results of the SF-36 questionnaire were as follows: median physical functioning score 100 (range 0-100), median physical problems score 100 (range 0-100), median bodily pain score 100 (range 45-100), median social functioning score 100 (range 25-100), median general mental health score 84 (range 40-92), median emotional problems score 100 (range 0-100), median vitality score 70 (range 35-80) and median general health perceptions score 70 (range 35-100). Mean QOL scores were similar to the general healthy population. CONCLUSION Surgery of ISH provides good QOL and tumoral control except for those located in the medulla oblongata. We recommend considering a careful multimodal therapeutic approach, including radiosurgery for these specific locations.
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Affiliation(s)
- Pierre-Jean Le Reste
- Department of Neurosurgery, Pontchaillou University Hospital, 35033, Rennes cedex 09, France
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Capitanio JF, Mazza E, Motta M, Mortini P, Reni M. Mechanisms, indications and results of salvage systemic therapy for sporadic and von Hippel–Lindau related hemangioblastomas of the central nervous system. Crit Rev Oncol Hematol 2013; 86:69-84. [DOI: 10.1016/j.critrevonc.2012.10.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 09/20/2012] [Accepted: 10/11/2012] [Indexed: 10/27/2022] Open
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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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Vortmeyer AO, Falke EA, Gläsker S, Li J, Oldfield EH. Nervous system involvement in von Hippel-Lindau disease: pathology and mechanisms. Acta Neuropathol 2013; 125:333-50. [PMID: 23400300 DOI: 10.1007/s00401-013-1091-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Revised: 01/25/2013] [Accepted: 01/26/2013] [Indexed: 02/06/2023]
Abstract
Patients with von Hippel-Lindau disease carry a germline mutation of the Von Hippel-Lindau (VHL) tumor-suppressor gene. We discuss the molecular consequences of loss of VHL gene function and their impact on the nervous system. Dysfunction of the VHL protein causes accumulation and activation of hypoxia inducible factor (HIF) which can be demonstrated in earliest stages of tumorigenesis and is followed by expression of VEGF, erythropoietin, nitric oxide synthase and glucose transporter 1 in VHL-deficient tumor cells. HIF-independent functions of VHL, epigenetic inactivation of VHL, pVHL proteostasis, and links between loss of VHL function and developmental arrest are also described. A most intriguing feature in VHL disease is the occurrence of primary hemangioblastic tumors in the nervous system, the origin of which has not yet been entirely clarified, and current hypotheses are discussed. Endolymphatic sac tumors may extend into the brain, but originally arise from proliferation of endolymphatic duct/sac epithelium; the exact nature of the proliferating epithelial cell, however, also has remained unclear, as well as the question why tumors almost consistently develop in the intraosseous portion of the endolymphatic sac/duct only. The epitheloid clear cell morphology of both advanced hemangioblastoma and renal clear cell carcinoma can make the differential diagnosis challenging, recent developments in immunohistochemical differentiation are discussed. Finally, metastasis to brain may not only be caused by renal carcinoma, but may derive from VHL disease-associated pheochromocytoma/paraganglioma, or pancreatic neuroendocrine tumor.
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Affiliation(s)
- Alexander O Vortmeyer
- Department of Pathology, Yale University School of Medicine, 416A Lauder Hall 310 Cedar Street, New Haven, CT 06520, USA.
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