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Kutia SA, Yarovaya OY, Kuznetsova EV, Obukhova DD, Kuznetsov VI. [Clinical anatomy of the Bernasconi-Cassinari artery]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:12-17. [PMID: 38512089 DOI: 10.17116/jnevro202412403212] [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] [Indexed: 03/22/2024]
Abstract
The article provides a comprehensive overview of the Bernasconi-Cassinari's artery (marginal tentorial branch of internal carotid artery, r. marginalis tentorii a. carotis internae). It includes information on the history of its discovery, anatomical features, and topography. The interrelation between the anatomical features of this artery and the presence of neurological pathology in patients is discussed, along with neurosurgical treatment methodologies.
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Affiliation(s)
- S A Kutia
- Vernadsky Crimean Federal University, Simferopol, Russia
| | - O Ya Yarovaya
- Vernadsky Crimean Federal University, Simferopol, Russia
| | - E V Kuznetsova
- Vernadsky Crimean Federal University, Simferopol, Russia
| | - D D Obukhova
- Vernadsky Crimean Federal University, Simferopol, Russia
| | - V I Kuznetsov
- Vernadsky Crimean Federal University, Simferopol, Russia
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Palavani LB, Andreão FF, de Abreu LV, Batista S, Borges J, Oliveira LDB, Bertani R, Filho JAA. Assessing the efficacy and safety of hemangioblastoma embolization: A comprehensive systematic review and meta-analysis. J Clin Neurosci 2023; 117:104-113. [PMID: 37788533 DOI: 10.1016/j.jocn.2023.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/16/2023] [Accepted: 09/24/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Hemangioblastomas (HBs) are highly vascular tumors linked to substantial morbidity and mortality. Recently, interventional neuroradiology has evolved rapidly, spurring interest in preoperative embolization as a possible HB treatment. PURPOSE This study evaluates the effectiveness and safety of preoperative embolization in managing HB. METHODS Adhering to PRISMA guidelines, this meta-analysis considered randomized and nonrandomized studies meeting specific criteria, encompassing intracranial HB and preoperative embolization. Primary outcomes were preoperative embolization efficacy and safety. Complications were classified as major (cerebellar ischemia, ischemic strokes, intratumoral hemorrhage, subarachnoid hemorrhage) and minor (transient nystagmus, slight facial nerve palsy, nausea, transient dysarthria, hemiparesis, hemisensory impairment, thrombotic complications, extravasation). RESULTS Thirteen studies involving 166 patients with preoperative embolization before HB resection were included. Two studies using the Glasgow Outcome Scale (GOS) showed 5 patients with good recovery, 6 with moderate disability, and 3 with severe disability. Major complications occurred in 1% (95% CI: 0% to 3%), and minor complications occurred in 1% (95% CI: 0% to 4%). Intraoperative blood loss during resection was estimated at 464.29 ml (95% CI: 350.63 ml to 614.80 ml). CONCLUSION Preoperative embolization holds promise in reducing intraoperative bleeding risk in neurosurgical intracranial HB treatment, primarily due to its low complication rates. Nonetheless, additional research and larger-scale studies are essential to establish its long-term efficacy and safety. These findings highlight preoperative embolization as a valuable tool for HB management, potentially enhancing future patient outcomes.
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Affiliation(s)
| | - Filipi Fim Andreão
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Sávio Batista
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Raphael Bertani
- Department of Neurosurgery, University of São Paulo, São Paulo, Brazil.
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Huisman TAGM, Patel R, Kralik S, Desai NK, Meoded A, Chen K, Weiner HL, Curry DJ, Lequin M, Kranendonk M, Orman G, Jallo G. Advances in Imaging Modalities for Pediatric Brain and Spinal Cord Tumors. Pediatr Neurosurg 2023; 58:240-258. [PMID: 37604135 DOI: 10.1159/000531998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/05/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Neuroimaging has evolved from anatomical imaging toward a multi-modality comprehensive anatomical and functional imaging in the past decades, important functional data like perfusion-weighted imaging, permeability imaging, diffusion-weighted imaging (DWI), and diffusion tensor imaging (DTI), tractography, metabolic imaging, connectomics, event-related functional imaging, resting state functional imaging, and much more is now being offered. SUMMARY Precision diagnostics has proven to be essential for precision treatment. Many minimal invasive techniques have been developed, taking advantage of digital subtraction angiography and interventional neuroradiology. Furthermore, intraoperative CT and/or MRI and more recently MR-guided focused ultrasound have complemented the diagnostic and therapeutic armamentarium. KEY MESSAGES In the current manuscript, we discuss standard imaging sequences including advanced techniques like DWI, DTI, susceptibility-weighted imaging, and 1H magnetic resonance spectroscopy, various perfusion weighted imaging approaches including arterial spin labeling, dynamic contrast enhanced imaging, and dynamic susceptibility contrast imaging. Pre-, intra, and postoperative surgical imaging including visualize imaging will be discussed. The value of connectomics will be presented for its value in neuro-oncology. Minimal invasive therapeutic possibilities of interventional neuroradiology and image-guided laser ablation and MR-guided high-intensity-focused ultrasound will be presented for treatment of pediatric brain and spinal cord tumors. Finally, a comprehensive review of spinal cord tumors and matching neuropathology has been included.
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Affiliation(s)
- Thierry A G M Huisman
- Divisions of Neuroradiology and Interventional Radiology, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Rajan Patel
- Divisions of Neuroradiology and Interventional Radiology, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Stephen Kralik
- Divisions of Neuroradiology and Interventional Radiology, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Nilesh K Desai
- Divisions of Neuroradiology and Interventional Radiology, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Avner Meoded
- Divisions of Neuroradiology and Interventional Radiology, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Karen Chen
- Divisions of Neuroradiology and Interventional Radiology, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Howard L Weiner
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital and Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Daniel J Curry
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital and Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Maarten Lequin
- Department of Radiology, Wilhelmina Children's Hospital and Princess Maxima Center for Pediatric Oncology University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mariette Kranendonk
- Department of Pathobiology, Princess Maxima Center for Pediatric Oncology University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gunes Orman
- Divisions of Neuroradiology and Interventional Radiology, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA,
| | - George Jallo
- Department of Neurosurgery, Institute for Brain Protection Sciences, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, USA
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Miyahara K, Okada T, Tanino S, Uriu Y, Tanaka Y, Suzuki K, Sekiguchi N, Noda N, Ichikawa T, Fujitsu K. Usefulness of posterior transpetrosal approach for the large solid cerebellopontine angle hemangioblastoma fed from multiple blood supplies: A technical case report. Surg Neurol Int 2023; 14:191. [PMID: 37404484 PMCID: PMC10316202 DOI: 10.25259/sni_38_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/12/2023] [Indexed: 07/06/2023] Open
Abstract
Background Extra-axial cerebellopontine angle (CPA) hemangioblastomas are rare clinical entity and surgical treatment is challenging due to the anatomical difficulties and multi-directional blood supplies. On the other hand, the risk of endovascular treatment for this disease has also been reported. Herein, we successfully applied a posterior transpetrosal approach to remove a large solid CPA hemangioblastoma without preoperative feeder embolization. Case Description A 65-year-old man presented with a complaint of diplopia during downward gaze. Magnetic resonance imaging revealed a solid tumor with homogeneous enhancement measuring about 35 mm at the left CPA, and the tumor compressed a left trochlear nerve. Cerebral angiography disclosed tumor-staining fed by both left superior cerebellar and left tentorial arteries. After the operation, the patient's trochlear nerve palsy improved dramatically. Conclusion This approach offers more optimal surgical working angle to the anteromedial part compared to the lateral suboccipital approach. In addition, the devascularization from the cerebellar parenchyma can be performed more reliably than the anterior transpetrosal approach. After all, this approach can be particularly useful when vascular-rich tumors receive blood supplies from multiple directions.
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Affiliation(s)
- Kosuke Miyahara
- Corresponding author: Kosuke Miyahara, Department of Neurosurgery, National Hospital Organization Yokohama Medical Center, Yokohama, Kanagawa, Japan.
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Vetrano IG, Gioppo A, Faragò G, Pinzi V, Pollo B, Broggi M, Schiariti M, Ferroli P, Acerbi F. Hemangioblastomas and Other Vascular Origating Tumors of Brain or Spinal Cord. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:377-403. [PMID: 37452946 DOI: 10.1007/978-3-031-23705-8_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Hemangioblastomas (HBs) are highly vascularized, slow-growing, rare benign tumors (WHO grade I). They account for about 2% of intracranial neoplasms; however, they are the most common primary cerebellar tumors in adults. Another frequent seat is the spinal cord (2-10% of primary spinal cord tumors). HBs are constituted by stromal and capillary vascular cells; macroscopically, HBs appear as nodular tumors, with or without cystic components. Although most of the HBs are sporadic (57-75%), they represent a particular component of von Hippel-Lindau disease (VHL), an autosomal dominant syndrome with high penetrance, due to a germline pathogenic mutation in the VHL gene, which is a tumor suppressor with chromosomal location on the short arm of chromosome three. VHL disease determines a variety of malignant and benign tumors, most frequently HBs, renal cell carcinomas, pheochromocytomas/paragangliomas, pancreatic neuroendocrine tumors, and endolymphatic sac tumors. Up to 20% of cases are due to de novo pathogenic variants without a family history. Many epidemiologic details of these tumors, especially the sporadic forms, are not well known. The median age of patients with sporadic HBS is about 40 years. More than two-third of VHL patients develop one or more central nervous system HBs during their lifetime; in case of VHL, patients at first diagnosis are usually younger than the patients with sporadic tumors. The most common presenting signs and symptoms are related to increased intracranial pressure, cerebellar signs, or spinal cord alterations in case of spinal involvement. Magnetic resonance imaging is the gold standard for the diagnosis, assessment, and follow-up of HBs, both sporadic and syndrome-related; angiography is rarely performed because the diagnosis is easily obtained with magnetic resonance. However, the diagnosis of an asymptomatic lesion does not automatically result in therapeutic actions, as the risks of treatment and the onset of possible neurological deficit need to be balanced, considering that HBs may remain asymptomatic and have a static or slow-growing behavior. In such cases, regular follow-up can represent a valid therapeutic option until the patients remain asymptomatic. There are no actual pharmacological therapies that are demonstrated to be effective for HBs. Surgery represents the primary therapeutic approach for these tumors. Observation or radiotherapy also plays a role in the long-term management of patients harboring HBs, especially in VHL; in few selected cases, endovascular treatment has been suggested before surgical removal. This chapter presents a systematic overview of epidemiology, clinical appearance, histopathological and neuroradiological characteristics of central nervous system HBs. Moreover, the genetic and molecular biology of sporadic and VHL HBS deserves special attention. Furthermore, we will describe all the available therapeutic options, along with the follow-up management. Finally, we will briefly report other vascular originating tumors as hemangioendotheliomas, hemangiomas, or angiosarcomas.
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Affiliation(s)
- Ignazio G Vetrano
- Neurovascular Surgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Gioppo
- Interventional Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giuseppe Faragò
- Interventional Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Valentina Pinzi
- Radiotherapy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Bianca Pollo
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Morgan Broggi
- Neurovascular Surgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco Schiariti
- Neurovascular Surgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paolo Ferroli
- Neurovascular Surgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Acerbi
- Neurovascular Surgery Unit and Experimental Microsurgical Laboratory, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via G. Celoria 11, 20133, Milan, Italy.
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Boutakioute B, Zouine Y, Chehboun A, Ouali M, Ganouni NCIE. Successful preoperative embolization of a cystic-solid variant of cerebellopontine angle hemangioblastoma. Radiol Case Rep 2022; 17:4799-4803. [PMID: 36212759 PMCID: PMC9535285 DOI: 10.1016/j.radcr.2022.09.045] [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: 08/17/2022] [Revised: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 11/01/2022] Open
Abstract
Tumors of the cerebellopontine angle (CPA) represent an heterogeneous group which can arise extradural, intradural-extraaxial or intraaxial compartment. Hemangioblastomas of the cerebellopontine angle (CPA) are extremely rare. Computed tomography (CT) and magnetic resonance imaging (MRI) are often the gold-standard radiological imaging modalities used in characterizing the lesion's features, and its relationship with the surrounding structures. They are vascular lesions and may cause profuse bleeding intraoperatively, that is why angiography remains a crucial diagnostic and therapeutic tool, by reducing both the presurgical differential diagnosis, as well as the intraoperative bleeding by providing capability of embolization of this vascular tumor. We present the case of a 65 year old patient with a cystic-solid variety of HMB at the right CPA, which was successfully treated by a combination of an endovascular preoperative embolization and surgery without major complications or neurological deficits.
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Li P, Tian Y, Song J, Yang Z, Zou X, Liu P, Zhu W, Chen L, Mao Y. Microsurgical intracranial hypervascular tumor resection immediately after endovascular embolization in a hybrid operative suite: A single-center experience. J Clin Neurosci 2021; 90:68-75. [PMID: 34275583 DOI: 10.1016/j.jocn.2021.05.026] [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: 10/13/2020] [Revised: 04/29/2021] [Accepted: 05/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study was performed to investigate the safety and outcome of one-stage hybrid endovascular and microsurgical treatment of intracranial hypervascular tumors. METHODS The blood supply of the tumor was endovascularly embolized just before microsurgery in a one-stage fashion. Clinical data regarding the preoperative neurological status, tumor characteristics, hybrid treatment details and complications, intraoperative blood loss, and postoperative outcomes were collected prospectively and then analyzed. RESULTS Beginning in July 2016, 13 patients (5 women, 8 men) with intracranial hypervascular tumors were enrolled in this study, with a mean age of 48.2 ± 10.9 years. The patients' tumors comprised seven hemangioblastomas, three hemangiopericytomas, two meningiomas, and one mesenchymal chondrosarcoma. The mean maximum tumor diameter was 54.9 ± 21.5 mm. No major procedural complications occurred except catheterization-related bleeding in one patient. The mean percentage of tumor devascularization was 65.0%±17.5%. Gross total resection was achieved in 12 patients (92.3%). The mean blood loss volume during microsurgical resection was 703.8 ± 886.8 mL (range, 150-3600 mL). Symptoms improved in three patients and remained stable in six patients. CONCLUSIONS One-stage hybrid embolization before intracranial hypervascular tumor resection is a safe and effective procedure to decrease intraoperative blood loss. It can prevent or treat embolization-related complications in a timely manner and avoid the risk of multiple surgical procedures.
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Affiliation(s)
- Peiliang Li
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yanlong Tian
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianping Song
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Zixiao Yang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiang Zou
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Peixi Liu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Wei Zhu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Liang Chen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China; State Key Laboratory of Medical Neurobiology, School of Basic Medical Sciences and Institutes of Brain Science, Fudan University, Shanghai 200032, China
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Akiyama T, Takahashi S, Nagoshi N, Ozawa H, Sasaki H, Toda M. Angioarchitecture and Pre-Surgical Embolization of Central Nervous System Solitary Fibrous Tumor/Hemangiopericytoma. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 15:316-322. [PMID: 37501902 PMCID: PMC10370977 DOI: 10.5797/jnet.oa.2020-0140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/31/2020] [Indexed: 07/29/2023]
Abstract
Objective Hemangiopericytomas (HPCs) and solitary fibrous tumors (SFTs) have been categorized as the same disease entity, SFT/HPC, since 2016. SFT/HPC is one of the most highly vascularized brain tumors, distinct from meningioma. The angioarchitecture also differs between these tumors. Understanding these differences can help interventionalists perform presurgical embolization more safely and effectively. Methods Vascular structures were analyzed in eight patients with central nervous system (CNS) SFT/HPCs, all of whom received presurgical embolization. The type of embolic materials used and the complication rates were compared between the CNS SFT/HPC cases and 39 meningioma cases treated within the same period. Characteristic angiographic features of SFT/HPC were identified, and we present their interpretation and utilization to inform embolization strategies. Results Four angiographic features of SFT/HPCs were identified. 1) Persistence of tumor stain and 2) feeders from branches of the internal carotid artery or vertebral artery were observed in all cases, while 3) connecting feeders (highly dilated vessels that originate from branches of other feeder vessels and run along the surface of one tumor compartment to feed another compartment) were observed in five out of eight cases. 4) Finally, an intratumoral arteriovenous shunt was identified in one case. The frequency of liquid embolic material use was significantly higher in SFT/HPC cases than in meningioma cases. No complications were observed in SFT/HPC cases, and all tumors were effectively removed. Conclusion The most appropriate presurgical embolization strategies differ between SFT/HPCs and meningiomas depending on the tumor angioarchitecture. A thorough understanding of the vascular anatomy is necessary for safe and effective embolization of SFT/HPCs.
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Affiliation(s)
- Takenori Akiyama
- Department of Neurosurgery, School of Medicine, Keio University, Tokyo, Japan
| | - Satoshi Takahashi
- Department of Neurosurgery, School of Medicine, Keio University, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopedics, School of Medicine, Keio University, Tokyo, Japan
| | - Hiroyuki Ozawa
- Department of Otorhinolaryngology, School of Medicine, Keio University, Tokyo, Japan
| | - Hikaru Sasaki
- Department of Neurosurgery, School of Medicine, Keio University, Tokyo, Japan
| | - Masahiro Toda
- Department of Neurosurgery, School of Medicine, Keio University, Tokyo, Japan
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Timonin SY, Konovalov NA. Surgical Treatment of Intramedullary Hemangioblastomas: Current State of Problem (Review). Sovrem Tekhnologii Med 2021; 13:83-94. [PMID: 35265353 PMCID: PMC8858416 DOI: 10.17691/stm2021.13.5.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Indexed: 12/25/2022] Open
Abstract
Intramedullary hemangioblastomas (HAB) refer to very rare highly vascularized vascular spinal cord tumors associated with various neurological disorders. Effective HAB therapy to a greater extent depends on diagnostic accuracy and the absence of intra- and postoperative complications. The present study is a review of publications concerned with modern diagnostic and therapeutic techniques to control spinal HAB. The authors showed that perfusion computed tomography, computed tomographic angiography, and magnetic resonance angiography can be reasonably used for diagnosis and differentiation in a number of HAB due to their high vascularization. Preoperative embolization significantly reducing intraoperative bleeding risks is highly efficient. Some authors recommend this procedure in case of large lesions and high risks of intraoperative bleeding. The review also considered intraoperative imaging of a tumor and its feeding vessels using indocyanine green providing inspectability over the total tumor resection and clear imaging of tumor vascular architecture. The advantages and restrictions of the mentioned procedures were described.
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Affiliation(s)
- S Yu Timonin
- PhD Student N.N. Burdenko National Medical Research Center for Neurosurgery, Ministry of Health of the Russian Federation, 16, 4 Tverskaya-Yamskaya St., Moscow, 125047, Russia
| | - N A Konovalov
- Professor, Corresponding Member of the Russian Academy of Sciences, Head of 10 Neurosurgery Department; Deputy Director for Science N.N. Burdenko National Medical Research Center for Neurosurgery, Ministry of Health of the Russian Federation, 16, 4 Tverskaya-Yamskaya St., Moscow, 125047, Russia
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Liu Z, Li L, Yi Z, Duan H, Lu R, Li C, Li L, Gong K. Biological and clinical impact of central nervous system hemangioblastomas in Chinese patients with von Hippel-Lindau disease: implications for treatment. Hered Cancer Clin Pract 2020; 18:21. [PMID: 33110457 PMCID: PMC7583299 DOI: 10.1186/s13053-020-00153-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 10/19/2020] [Indexed: 12/15/2022] Open
Abstract
Objective Central nervous system (CNS) hemangioblastomas (HGBs) are the most frequent cause of mortality in patients with von Hippel-Lindau (VHL) genetic syndrome. However, there is a lack of large studies on the clinical features and optimal management of HGBs in Chinese patients. Methods VHL-related HGB cases treated surgically at our hospital from 2012 to 2019 were evaluated. Patients and family members meeting the clinical diagnostic criteria underwent genetic testing. Clinical, genetic and relevant imaging data were analyzed. Results Eighty-five VHL patients from 34 pedigrees in 16 Chinese provinces who underwent 121 operations for CNS HGBs were enrolled. Multiple operations were associated with a younger age at first operation (OR = 0.926, 95% CI = 0.871–0.985, P = 0.014, threshold: 27.5, sensitivity: 72.2%, specificity: 71.2%) and a longer postoperative period (OR = 1.096, 95% CI = 1.015–1.184, P = 0.019, threshold: 10.5, sensitivity: 66.7%, specificity: 76.3%). The age at first operation was younger in children than in their parents (23 pairs, P < 0.001). The age at first operation was younger in siblings born later than in those born earlier (10 pairs, P = 0.01). Most untreated tumors (98.2%) remained relatively stable during follow-up (range, 0.5–7; median, 2). However, new tumors continued to emerge (0.14 tumor/year). Conclusion VHL-associated CNS HGB is a long-term chronic disease with repeated attacks, likely with genetic anticipation in Chinese pedigrees. When the age at first operation is under 27.5 years, or the postoperative period is longer than 10.5 years, the risk of multiple operations is increased. While most unresected HGBs remain stable after surgery, new tumors may still slowly emerge; hence, scheduled follow-ups are necessary.
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Affiliation(s)
- Zhen Liu
- Department of Neurosurgery, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034 China
| | - Liang Li
- Department of Neurosurgery, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034 China
| | - Zhiqiang Yi
- Department of Neurosurgery, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034 China
| | - Hongzhou Duan
- Department of Neurosurgery, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034 China
| | - Runchun Lu
- Department of Neurosurgery, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034 China
| | - Chunwei Li
- Department of Neurosurgery, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034 China
| | - Lei Li
- Department of Urology, Peking University First Hospital, Beijing, 100034 China
| | - Kan Gong
- Department of Urology, Peking University First Hospital, Beijing, 100034 China
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Abstract
RATIONALE Hemangioblastomas (HMGs) originating from the cerebellopontine angle (CPA) are extremely uncommon. Nevertheless, the cystic-solid form of this lesion at the above location is even rarer. PATIENT CONCERNS We present a 31-years old male with a right ear hearing loss of 3 months duration. He did not experience earache or discharge before the hearing loss. He; however, experienced visual acuity and dizziness. General physical examination did not yield much. DIAGNOSES Computed tomography and magnetic resonance imaging revealed a cystic-solid mass at right CPA. We initial misdiagnosed the lesion as an acoustic neuroma with cystic changes. Immunohistochemistry studies revealed HMG. INTERVENTIONS The lesion was total surgical resection via the retro-sigmoid approach. OUTCOMES The patient's symptomatology resolved after the surgery. Two years follow-up show no recurrence of the lesion and the patient is well. LESIONS Identification of feeding arteries and electro-coagulating them during the operation minimized intraoperative bleeding. The tumor should usually be dissected out whole and not piece meal fashion. Pre-operative CTA is very useful in outlining the vasculature of the tumor.
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Affiliation(s)
- Zhigang Lan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Seidu A Richard
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
- Department of Medicine, Princefield University, Ghana, West Africa
| | - Yuekang Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
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Krüger MT, Steiert C, Gläsker S, Klingler JH. Minimally invasive resection of spinal hemangioblastoma: feasibility and clinical results in a series of 18 patients. J Neurosurg Spine 2019; 31:880-889. [PMID: 31398701 DOI: 10.3171/2019.5.spine1975] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 05/28/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Hemangioblastomas are benign, highly vascularized tumors that can occur sporadically or as part of von Hippel-Lindau (VHL) disease. Traditionally, spinal hemangioblastomas have been surgically treated via an open approach. In recent years, however, minimally invasive techniques using tubular retractors have been increasingly applied in spine surgery. Such procedures involve less tissue trauma but are also particularly demanding for the surgeon, especially in cases of highly vascular tumors such as hemangioblastomas. The object of this study was to evaluate the safety and efficacy of minimally invasive resection of selected spinal hemangioblastomas. METHODS The authors conducted a retrospective single-center study of all patients who, between January 2010 and January 2018, had been operated on for spinal hemangioblastoma via a minimally invasive approach performed at the surgeon's discretion. The surgical technique is described and the pre- and postoperative neurological and imaging results were analyzed descriptively. The primary outcome was the postoperative compared to preoperative neurological condition (McCormick grade). The secondary outcomes were the extent of tumor resection and postoperative complications. RESULTS Eighteen patients, 12 female and 6 male, harboring a total of 19 spinal hemangioblastomas underwent surgery in the study period. Seventeen patients had stable neurological findings with stable or improved McCormick grades (94.5%) at a mean of 4.3 months after surgery. One (5.5%) of the 18 patients developed progressive neurological symptoms with a worsened McCormick grade that did not improve in the long-term follow-up. Sixteen of the 18 patients had VHL disease, whereas 2 patients had sporadic spinal hemangioblastomas. In all patients, postoperative MRI showed complete resection of the tumors. No other surgery-related perioperative or postoperative complications were recorded. CONCLUSIONS A minimally invasive approach for the resection of selected spinal hemangioblastomas is safe and allows complete tumor resection with good clinical results in experienced hands.
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Affiliation(s)
- Marie T Krüger
- 1Department of Neurosurgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- 2Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Christine Steiert
- 1Department of Neurosurgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sven Gläsker
- 1Department of Neurosurgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- 3Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jan-Helge Klingler
- 1Department of Neurosurgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Shinya T, Nagamine H, Sugawara KI, Ishiuchi S. The usefulness of indocyanine green during surgery for hypervascular posterior fossa tumors. Surg Neurol Int 2018; 9:90. [PMID: 29770250 PMCID: PMC5938893 DOI: 10.4103/sni.sni_19_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 04/02/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Cerebral hemangioblastomas are benign tumors with abundant blood flow that occur mainly in the posterior fossa. Tumor removal en bloc is important in surgical treatment because of the risk of bleeding; however, it is actually rather difficult in practice. Therefore, we propose a surgical strategy for visualizing hypervascular tumors of the posterior fossa utilizing indocyanine green (ICG). CASE DESCRIPTION Case 1 involved a 48-year-old male with a history of von Hippel-Lindau (VHL) disease. Magnetic resonance imaging (MRI) revealed a solid tumor measuring 3.0 cm in diameter in the right cerebellopontine angle. We performed surgery because the tumor was pressing against the brainstem. Surgery was performed via the posterior subtemporal transtentorial approach in order to visualize the feeding artery and draining vein intraoperatively. The vessels were confirmed by ICG and the tumor was removed en bloc. Case 2 involved a 30-year-old woman. Signs of increased intracranial pressure were noted, and an MRI revealed a solid tumor 3.5 cm in diameter in the left cerebellar hemisphere. Surgery was performed via the midline suboccipital approach. Similarly, we confirmed the vessels using ICG and the tumor was removed en bloc. CONCLUSIONS For hypervascular tumors of the posterior fossa, preoperative image assessment is important. Furthermore, the use of ICG during surgery is advantageous for surgical strategies where the feeding arteries and draining veins exist superficially in the operative field and are therefore easier to remove en bloc.
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Affiliation(s)
- Takahiro Shinya
- Department of Neurosurgery, University of the Ryukyus Faculty of Medicine Hospital, Okinawa, Japan
| | - Hideki Nagamine
- Department of Neurosurgery, University of the Ryukyus Faculty of Medicine Hospital, Okinawa, Japan
| | - Ken-ichi Sugawara
- Department of Neurosurgery, University of the Ryukyus Faculty of Medicine Hospital, Okinawa, Japan
| | - Shogo Ishiuchi
- Department of Neurosurgery, University of the Ryukyus Faculty of Medicine Hospital, Okinawa, Japan
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Staudt MD, Hebb MO. Staged multi-modality treatment approaches for giant cerebellopontine angle hemangioblastomas. J Clin Neurosci 2018; 53:224-228. [PMID: 29685408 DOI: 10.1016/j.jocn.2018.04.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 04/09/2018] [Indexed: 11/30/2022]
Abstract
Giant hemangioblastomas (HBs) located in the cerebellopontine angle (CPA) present rare, high risk neurosurgical challenges. En bloc resection has been traditionally recommended for HBs, however this approach may pose unacceptable risk with giant tumors. Alternative treatment strategies have not been well described and the relevant literature is scant. This case review includes an illustrative patient with a giant, symptomatic CPA HB. It was felt that the neurovascular and tumor attributes were favorable for a multi-modality treatment strategy rather than circumferential dissection to remove this formidable tumor. A staged approach consisting of preoperative HB devascularization, debulking and piecemeal resection followed by radiosurgery for a small residuum produced an excellent clinical outcome. Variations of this unconventional multi-modality strategy may reduce the perioperative morbidity of carefully selected patients with giant CPA HBs. A thorough literature review is provided.
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Affiliation(s)
- Michael D Staudt
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Matthew O Hebb
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
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Eskey CJ, Meyers PM, Nguyen TN, Ansari SA, Jayaraman M, McDougall CG, DeMarco JK, Gray WA, Hess DC, Higashida RT, Pandey DK, Peña C, Schumacher HC. Indications for the Performance of Intracranial Endovascular Neurointerventional Procedures: A Scientific Statement From the American Heart Association. Circulation 2018; 137:e661-e689. [PMID: 29674324 DOI: 10.1161/cir.0000000000000567] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intracranial endovascular interventions provide effective and minimally invasive treatment of a broad spectrum of diseases. This area of expertise has continued to gain both wider application and greater depth as new and better techniques are developed and as landmark clinical studies are performed to guide their use. Some of the greatest advances since the last American Heart Association scientific statement on this topic have been made in the treatment of ischemic stroke from large intracranial vessel occlusion, with more effective devices and large randomized clinical trials showing striking therapeutic benefit. The treatment of cerebral aneurysms has also seen substantial evolution, increasing the number of aneurysms that can be treated successfully with minimally invasive therapy. Endovascular therapies for such other diseases as arteriovenous malformations, dural arteriovenous fistulas, idiopathic intracranial hypertension, venous thrombosis, and neoplasms continue to improve. The purpose of the present document is to review current information on the efficacy and safety of procedures used for intracranial endovascular interventional treatment of cerebrovascular diseases and to summarize key aspects of best practice.
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Cavernous Sinus Aneurysm Associated With Cerebellar Hemangioblastoma in an Adult With von Hippel-Lindau Disease. J Craniofac Surg 2018; 29:e502-e506. [PMID: 29608473 DOI: 10.1097/scs.0000000000004545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A case of cerebellar hemangioblastoma with von Hippel-Lindau disease and an aneurysm of the cavernous sinus segment of the internal carotid artery is presented here. A 60-year-old woman presented with a cerebellar solid tumor manifesting as headache of 4 months, progressive vomiting, and ataxia of half a month. Four-vessel angiography revealed a high stain mass tumor located in the posterior fossa; an aneurysm on the cavernous sinus segment of the internal carotid artery was demonstrated at the same time. The ipsilateral anterior inferior cerebellar artery (AICA) and posterior inferior cerebellar artery (PICA) branches were the main feeding vessels of the hemangioblastoma. The patient underwent left-lateral suboccipital craniectomy to remove the highly vascular hemangioblastoma. Successful total excision of the tumor was demonstrated on postoperative magnetic resonance (MR) images. The unruptured cavernous sinus aneurysm in this case was not on the feeding artery, which was asymptomatic and has not been treated further. The patient was in good condition in 1-year follow-up.
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Akinduro OO, Mbabuike N, ReFaey K, Yoon JW, Clifton WE, Brown B, Wharen RE, Quinones-Hinojosa A, Tawk RG. Microsphere Embolization of Hypervascular Posterior Fossa Tumors. World Neurosurg 2018; 109:182-187. [DOI: 10.1016/j.wneu.2017.09.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 11/16/2022]
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18
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Yanez N, Cifuentes LK, Mejia M, Useche JN. Advantages of using a detachable-tip microcatheter and liquid embolic agents in the preoperative embolization of a recurrent cerebellar hemangioblastoma: A case report. Surg Neurol Int 2017; 8:239. [PMID: 29026675 PMCID: PMC5629862 DOI: 10.4103/sni.sni_123_17] [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] [Received: 03/29/2017] [Accepted: 07/24/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The preferred treatment for intracranial hemangioblastomas is surgical resection with or without preoperative embolization, however, embolization remains controversial due to risks such as distal tip entrapment, vascular injury during navigation, and embolic agent migration. CASE DESCRIPTION A 54-year-old woman was admitted for surgical resection and preoperative embolization of a cerebellar hemangioblastoma. Although experience using Onyx with detachable and nondetachable tip microcatheters has been well reported in a variety of clinical circumstances, we describe the first case of a presurgical embolization of an intra-axial tumor using a second-generation detachable-tip microcatheter and a nonadhesive liquid embolic agent. Following the procedure, a nearly complete angiographic obliteration was achieved, as well as a successful subsequent surgical resection. CONCLUSION Preoperative embolization with detachable-tip microcatheters and liquid embolic agents should be taken into consideration when assessing patients with hemangioblastomas of the posterior fossa due to the reduced risks of cardiac arrest, hemorrhage, and death.
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Affiliation(s)
- Nicolas Yanez
- School of Medicine, Universidad de los Andes, Bogota DC, Colombia.,Department of Diagnostic and Interventional Imaging, Hospital Universitario Fundacion Santa Fe de Bogota, Bogota DC, Colombia
| | - Luisa K Cifuentes
- Department of Diagnostic and Interventional Imaging, Hospital Universitario Fundacion Santa Fe de Bogota, Bogota DC, Colombia
| | - Marcela Mejia
- Department of Pathology, Hospital Universitario Fundacion Santa Fe de Bogota, Bogota DC, Colombia
| | - Juan N Useche
- Department of Diagnostic and Interventional Imaging, Hospital Universitario Fundacion Santa Fe de Bogota, Bogota DC, Colombia
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Cheng J, Liu W, Zhang S, Lei D, Hui X. Clinical Features and Surgical Outcomes in Patients with Cerebellopontine Angle Hemangioblastomas: Retrospective Series of 23 Cases. World Neurosurg 2017; 103:248-256. [PMID: 28400229 DOI: 10.1016/j.wneu.2017.03.144] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Hemangioblastomas in the cerebellopontine angle (CPA) are uncommon and have rarely been reported. They may be easily misdiagnosed because of the atypical location and clinical and imaging features. The present study aimed to characterize clinical and radiologic features, treatment strategies, and outcomes in these rare lesions and to investigate various factors that may affect postoperative outcomes. METHODS The medical records of patients with CPA hemangioblastomas who underwent surgery from 2003-2016 at the West China Hospital were reviewed retrospectively and statistically analyzed. RESULTS Twenty-three patients (14 males and 9 females) presented with CPA hemangioblastomas. Eight patients (34.8%) had von Hippel-Lindau (VHL) syndrome. Gross total resection was achieved in 22 patients (95.6%). The mean follow-up was 45.1 ± 36.2 months (range 3-144 months). After surgery, the symptoms improved in 18 cases (78.3%), remained unchanged in 3 cases (13%), and were aggravated in 2 cases (8.7%). Four patients showed local recurrence during follow-up (17.4%). Patients with cystic hemangioblastomas had a better neurologic improvement (P = 0.041) compared with patients with solid tumors. Furthermore, patients with maximal diameter of tumors >3 cm (P = 0.035) or solid tumors (P = 0.018) showed a higher incidence of postoperative complications. The local recurrence was correlated with VHL disease (P = 0.027). CONCLUSIONS Although hemangioblastomas of the CPA are challenging lesions to treat surgically, they can be removed safely when these lesions are appropriately diagnosed and treated. Patients with VHL disease are more likely to have a local recurrence. A regular follow-up is recommended to detect the local and distant recurrence, even if the clinical course is benign and the tumor is totally resected.
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Affiliation(s)
- Jian Cheng
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wenke Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Si Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ding Lei
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xuhui Hui
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
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Laviv Y, Thomas A, Kasper EM. Hypervascular Lesions of the Cerebellopontine Angle: The Relevance of Angiography as a Diagnostic and Therapeutic Tool and the Role of Stereotactic Radiosurgery in Management. A Comprehensive Review. World Neurosurg 2016; 100:100-117. [PMID: 28049034 DOI: 10.1016/j.wneu.2016.12.091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/18/2016] [Accepted: 12/20/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND The cerebellopontine angle (CPA) is a narrowed skull base area containing important cranial nerves and vessels and bordering with eloquent areas of the posterior fossa. Tumors of the CPA are a heterogeneous group and can have extradural, intradural/extra-axial, or intra-axial origins. Their vascular supply changes depending on their anatomic origin. Symptomatic, large CPA tumors require surgical resection in order to prevent irreversible, severe neurological damages. However, its tight and strategical location make surgery in the CPA very challenging and require appropriate pre-surgical planning. Pre-surgical diagnosis is of great importance as it allows us to choose the optimal management for the particular patient. This is of further significance when encountering high-risk lesions such as hypervascular tumors. Neurosurgeons should utilize every available pre-surgical diagnostic modalities as well as neo-adjuvant treatments in order to reduce such risks. METHODS We review all reported cases of hypervascular lesions of the CPA and discuss the roles of angiography and stereotactic radiosurgery in their management. RESULTS Three lesions of the CPA can be considered as truly hypervascular: hemangioblastomas, hemangiopericytomas and paragangliomas. All lesions share many radiological features. However, each lesion has a different anatomical origin and hence, has a characteristic vascular supply. Pre-surgical angiography can be utilized as a diagnostic tool to narrow down the differential diagnosis of a vascular CPA lesion, based on the predominant supplying vessel. In addition, pre-surgical embolization at time of angiography will narrow the associated surgical risks. CONCLUSIONS Angiography is a crucial diagnostic and therapeutic tool, helping both in narrowing the presurgical differential diagnosis and in controlling intraoperative bleeding. Because of the high surgical risks associated with resection of vascular tumors in the CPA, noninvasive treatments, such as stereotactic radiosurgery, also may have a crucial role.
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Affiliation(s)
- Yosef Laviv
- Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
| | - Ajith Thomas
- Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ekkehard M Kasper
- Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Cui H, Zou J, Bao YH, Wang MS, Wang Y. Surgical treatment of solid hemangioblastomas of the posterior fossa: A report of 28 cases. Oncol Lett 2016; 13:1125-1130. [PMID: 28454223 PMCID: PMC5403715 DOI: 10.3892/ol.2016.5531] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 10/07/2016] [Indexed: 11/05/2022] Open
Abstract
This study evaluated the clinical features, treatment strategies and outcomes of solid hemangioblastomas in 28 patients diagnosed with hypervascular lesions in the posterior fossa. Preoperative embolization of the feeding arteries had limited effects, with only 7 patients benefitting from it for the reduction of intraoperative hemorrhage. The tumor was completely removed in all patients, and 22 patients had a full recovery, while 6 patients, all of whom had van Hippel Lindau disease, developed recurrences. The present study demonstrated that meticulous en bloc surgical resection was the optimal treatment for solid hemangioblastomas of the posterior fossa. For large tumors, preoperative embolization was critical for preventing postoperative morbidity. Given the improvements in microsurgical techniques and the understanding of the tumor vascular pattern, total tumor removal associated with a low mortality rate could be achieved.
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Affiliation(s)
- Hua Cui
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, P.R. China
| | - Jian Zou
- Department of Clinical Laboratory Science, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu 214023, P.R. China
| | - Ying-Hui Bao
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, P.R. China
| | - Ming-Sheng Wang
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, P.R. China
| | - Yong Wang
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, P.R. China
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Ji YC, Li Y, Hu JX, Zhang HB, Yan PX, Zuo HC. Cerebellar hemangioblastoma mimicking an aneurysm: A case report and literature review. Oncol Lett 2016; 12:2622-2624. [PMID: 27698835 PMCID: PMC5038381 DOI: 10.3892/ol.2016.4979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/15/2016] [Indexed: 11/26/2022] Open
Abstract
Hemangioblastomas (HBMs) are highly vascular tumors of the central nervous system. Sporadic HBMs are nearly always solitary, and solitary HBMs are similar to intracranial arteriovenous malformations due to their highly vascular characteristics. However, to the best of our knowledge, cases of HBM in the cerebellum mimicking an aneurysm have never been reported in the literature. The present study reports a case of an HBM on the right cerebellar hemisphere mimicking an aneurysm, which originated from the right posterior inferior cerebellar artery, as determined using magnetic resonance angiography and digital subtraction angiography. The patient was admitted the Department of Neurosurgery at the Tsinghua University Yuquan Hospital (Beijing, China) in January 2015 due to a 4-year history of intermittent headaches. The diagnosis of an HBM was determined during surgery and the tumor was totally resected by changing the operation technique, with no complications. In conclusion, it is difficult to distinguish between HBMs and intracranial vascular diseases, particularly aneurysms. Surgeons should consider the possibility carefully prior to surgery and careful prepare for each eventuality.
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Affiliation(s)
- Yu-Chen Ji
- Department of Neurosurgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, P.R. China
| | - Yan Li
- Department of Neurosurgery, Tsinghua University Yuquan Hospital, Beijing 100040, P.R. China
| | - Jing-Xia Hu
- Department of Neurosurgery, Tsinghua University Yuquan Hospital, Beijing 100040, P.R. China
| | - Hong-Bo Zhang
- Department of Neurosurgery, Xinhua Hospital of Hubei, Wuhan, Hubei 430015, P.R. China
| | - Peng-Xiang Yan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Huan-Cong Zuo
- Department of Neurosurgery, Tsinghua University Yuquan Hospital, Beijing 100040, P.R. China
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Safety and outcomes of preoperative embolization of intracranial hemangioblastomas: A systematic review. Clin Neurol Neurosurg 2016; 150:143-151. [PMID: 27668858 DOI: 10.1016/j.clineuro.2016.09.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/05/2016] [Accepted: 09/18/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION While preoperative embolization is often reserved for large and highly vascular tumors in order to minimize blood loss, its safety and efficacy in the treatment of hemangioblastomas (HB) is unclear. We present the largest systematic review focusing on the safety and outcome of preoperative embolization of intracranial HB. MATERIALS AND METHODS To identify all cases of preoperative embolization for HB, a literature search was conducted via Medline (OVID and PubMed), Scopus, Embase, and Web of Science. Studies that were in English, included intracranial hemangioblastomas treated with preoperative embolization and provided sufficient disaggregated clinical data for each patient were included. Historical control patients with non-embolized intracranial HB undergoing resection were similarly identified. RESULTS A total of 111 patients that underwent preoperative embolization of HB prior to planned resection were identified. Patient age ranged from 12 to 72 years, with a cohort of 63% males and 36% females. Nine studies comprising 392 non-embolized patients were included as controls. Gross total resection was achieved in 83.7% of embolized and 95.6% of non-embolized patients. Intraoperative blood transfusion was required in 15.3% of embolized and 0.51% of non-embolized controls, while rates of post-operative hemorrhage were 8.4% and 1.6%, respectively. Complication rates from embolization were 11.7% and following consequent surgery were 20.7%. DISCUSSION Embolization did not increase rates of gross total resection, decrease estimated blood loss, or decrease incidence of complications. Not only does embolization fail to mitigate surgical risks, the embolization procedure itself carries significant risk for complications. Embolization should not be standard of care for intracranial HB.
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The analysis of correlative factors affecting long-term outcomes in patients with Solid Cerebellar Hemangioblastomas. Clin Neurol Neurosurg 2016; 150:59-66. [PMID: 27588372 DOI: 10.1016/j.clineuro.2016.08.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 08/26/2016] [Accepted: 08/27/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Analyze the factors affecting postoperative outcomes in patients with solid cerebellar hemangioblastomas. PATIENTS AND METHODS We retrospectively analyzed the clinical data of 22 patients with sporadic solid cerebellar hemangioblastomas. Data regarding the clinical materials and imaging features, diameter of the lesion, operative approaches and postoperative complications were analyzed in all patients. The factors that may affect the recovery of postoperative patients were analyzed by univariate analysis and logistic regression multivariate analysis. RESULTS All 22 patients were diagnosed with sporadic solid cerebellar hemangioblastomas; total resection was achieved in 21 of 22 patients (95.5%). Six patients with combined obstructive hydrocephalus received a ventricle-peritoneal shunt preoperatively. The mean duration of the follow-up period was 25.5 months (range, 6-72 months). Tumor recurrence occurred in two patients with poor prognosis at 12 months and 56 months after surgery. According to outcome, patients were divided into the poor group (4 of 22 patients, 18.2%), in which neurological symptoms persisted postoperatively, or were worse than preoperatively, and the good group (18 of 22 patients, 81.8%) with no neurological signs or improved symptoms postoperatively. After univariate analysis, the factor affecting the final outcome was postoperative hemorrhage (P=0.003). Moreover, multiple logistic regression analysis via R software indicated that postoperative hemorrhage (p=0.008) was correlated with outcomes. CONCLUSIONS Postoperative hemorrhage is a factor correlated with final outcomes of patients with sporadic solid cerebellar hemangioblastomas.
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Giammattei L, Messerer M, Aghakhani N, David P, Herbrecht A, Richard S, Parker F. Surgical resection of medulla oblongata hemangioblastomas: outcome and complications. Acta Neurochir (Wien) 2016; 158:1333-41. [PMID: 27185165 DOI: 10.1007/s00701-016-2834-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
Abstract
OBJECT The purpose of this study was to analyze the surgical outcome and complications of a single-center series of medulla oblongata (MO) hemangioblastomas. METHODS We retrospectively reviewed the medical charts of all medulla oblongata hemangioblastomas operated on at our institution between 1996 and 2015. All patients had a pre- and postoperative MRI and a minimum follow-up of 6 months. Patients were scored according to the Karnofsky Performance Scale (KPS) and McCormick Scale at the moment of admission, discharge and the last follow-up. RESULTS Thirty-one surgical procedures were performed on 27 patients (16 females and 11 males). The mean age was 33 years, and 93 % of patients had von Hippel Lindau (VHL) disease. Three patients experienced very complicated postoperative courses, with one case ending in the death of the patient. Two patients required tracheostomy. According to McCormick's classification, 7 (23 %) of the 31 operations resulted in aggravation and 23 (74 %) in no change. Considering the seven patients with aggravation at discharge, four patients (60 %) returned to their preoperative status, one (14 %) improved but remained below his preoperative McCormick grade and two (29 %) did not improve. At last follow-up, KPS was ameliorated in 53 %, stable in 40 % and worsened in 7 % of cases. CONCLUSION Surgery of medulla oblongata hemangioblastomas is a challenging procedure characterized by an acceptable morbidity. Transient morbidity is not negligible even if the long-term outcome is in most cases favorable. A compromised neurological condition seems to be the best predictor of unfavorable outcome.
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Rabadán AT, Hernández DA, Paz L. Hemangioblastoma located in the posterior incisural space mimicking a tentorial meningioma: a case report. J Med Case Rep 2016; 10:183. [PMID: 27339157 PMCID: PMC4918118 DOI: 10.1186/s13256-016-0962-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 05/30/2016] [Indexed: 01/14/2023] Open
Abstract
Background The most common type of vascularized tumor located in the posterior incisural space in older patients is the falcotentorial meningioma. Solid hemangioblastomas are rarely found in this particular area of the brain. To the best of our knowledge, the case of only one patient harboring a hemangioblastoma not associated with Von Hippel-Lindau disease has been previously reported in the literature in this anatomic region. Regarding age presentation, it is rare for sporadic hemangioblastoma in any part of the brain to occur in older patients; only two cases have previously been reported, and neither were in this anatomical space. A solid hemangioblastoma represents a surgical challenge because of its high vascularization, very similar to an arteriovenous malformation, and it should be removed en bloc to prevent significant intraoperative bleeding. Case presentation We report here the case of a 63-year-old white male patient with a sporadic hemangioblastoma located in the posterior incisural space mimicking a tentorial meningioma. It was completely removed en bloc via an infratentorial supracerebellar approach with an excellent outcome. Conclusions A hemangioblastoma should be considered among the differential diagnosis of hypervascularized masses in the posterior incisural space, even in cases of solid tumors, in older patients, or in the absence of Von Hippel-Lindau disease. These tumors located in the posterior incisural space represent a challenge, and the infratentorial supracerebellar approach provides panoramic exposure to allow safe resection.
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Affiliation(s)
- Alejandra T Rabadán
- Institute of Medical Research A Lanari, University of Buenos Aires, Combatiente de Malvinas 3150. 1427, Buenos Aires, Argentina.
| | - Diego A Hernández
- Institute of Medical Research A Lanari, University of Buenos Aires, Combatiente de Malvinas 3150. 1427, Buenos Aires, Argentina
| | - Leonardo Paz
- Institute of Medical Research A Lanari, University of Buenos Aires, Combatiente de Malvinas 3150. 1427, Buenos Aires, Argentina
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Ene CI, Xu D, Morton RP, Emerson S, Levitt MR, Barber J, Rostomily RC, Ghodke BV, Hallam DK, Albuquerque FC, McDougall CG, Sekhar LN, Ferreira M, Kim LJ, Chang SW. Safety and Efficacy of Preoperative Embolization of Intracranial Hemangioblastomas. Oper Neurosurg (Hagerstown) 2016; 12:135-140. [PMID: 29506092 DOI: 10.1227/neu.0000000000001014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 07/20/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intracranial hemangioblastomas are highly vascular tumors that account for 1% to 2% of all central nervous system tumors. Preoperative embolization has been proposed to limit the often significant intraoperative blood loss associated with resection and potentially make the tumor more soft/necrotic and thus more amenable to gross total resection. The safety and efficacy of preoperative embolization of intracranial hemangioblastomas, however, are not well characterized. OBJECTIVE To evaluate the safety and efficacy of preoperative endovascular embolization of intracranial hemangioblastomas using a variety of embolic agents. METHODS A retrospective review of all surgically resected intracranial hemangioblastomas treated with preoperative embolization between 1999 and 2014 at 2 high-volume centers was performed. Clinical and radiographic criteria, including von Hippel-Lindau status, magnetic resonance imaging tumor characteristics, embolization-related complications, degree of angiographic devascularization, intraoperative blood loss, ability to obtain gross total resection, transfusion requirements, and operative time, were analyzed. RESULTS A total of 54 patients underwent surgery, with 24 undergoing preoperative embolization followed by surgical resection, and 30 patients undergoing surgical resection alone. Embolization-related neurological complications were seen in 6 patients (25%), including 3 hemorrhages when polyvinyl alcohol particles (P = .04) were used and 3 infarctions when liquid embolic agents were used (P = .27). Permanent neurological deficits were seen in 15%. CONCLUSION Preoperative embolization of intracranial hemangioblastomas should be performed with caution, given the potential for neurological morbidity. Further studies are needed to help guide patient and embolic agent selection.
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Affiliation(s)
- Chibawanye I Ene
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - David Xu
- Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Ryan P Morton
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Samuel Emerson
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Michael R Levitt
- Department of Radiology, University of Washington, Seattle Washington
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Robert C Rostomily
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Basavaraj V Ghodke
- Department of Neurological Surgery, University of Washington, Seattle, Washington.,Department of Radiology, University of Washington, Seattle Washington
| | - Danial K Hallam
- Department of Neurological Surgery, University of Washington, Seattle, Washington.,Department of Radiology, University of Washington, Seattle Washington
| | - Felipe C Albuquerque
- Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Cameron G McDougall
- Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Laligam N Sekhar
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Manuel Ferreira
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Louis J Kim
- Department of Neurological Surgery, University of Washington, Seattle, Washington.,Department of Radiology, University of Washington, Seattle Washington
| | - Steve W Chang
- Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Saliou G, Giammattei L, Ozanne A, Messerer M. Role of preoperative embolization of intramedullary hemangioblastoma. Neurochirurgie 2016; 63:372-375. [PMID: 27236735 DOI: 10.1016/j.neuchi.2016.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 01/10/2016] [Accepted: 01/26/2016] [Indexed: 11/18/2022]
Abstract
OBJECT Hemangiobastomas (HB) are rare lesions accounting for 1 to 5% of all spinal cord tumors. Due to their hypervascular nature, an angiography may be proposed preoperatively in order to identify tumoral vascular anatomy. Preoperative embolization may be indicated to reduce intraoperative bleeding, thus facilitating tumor resection and minimizing surgical risk. The aim of this paper is to report our experience of preoperative embolization in intramedullary hemangioblastomas. METHODS We performed a retrospective analysis of all patients operated on for intramedullary hemangioblastomas between 1995 and 2014 who had undergone embolization before surgery. RESULTS Seven patients were analyzed: there were 6 females and 1 male, mean age 43years, 6 patients had Von Hippel-Lindau disease. Four tumors were located in the cervical spine and three in the dorsal spine. The average maximum sagittal diameter was 19mm (range 8-32mm), while the average maximum axial diameter was 11.5mm (range 6-21mm). The embolic agent used was Histoacryl (NBCA). Endovascular embolization was routinely performed the day before surgery. One patient experienced a major preoperative complication with a vertebrobasilar infarctus with consequent unilateral cerebellar syndrome and gait instability. Minor extravasation of embolic agent was observed in two cases. In one of these two cases, there was also the penetration of the embolic agent in the tumor; the resection was impossible due to the hard consistency of the tumor. In the other 6 patients, the resection was total. Six patients had identical preoperative and postoperative McCormick score and one patient shifted to a better score at follow-up. CONCLUSION Preoperative endovascular embolization is an effective adjunct treatment. It is useful in reducing the surgical bleeding and thus the operative risks. The procedure is not always safe and complications could occur. We recommend preoperative embolization in selected cases.
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Affiliation(s)
- G Saliou
- Service de neuroradiologie interventionnelle, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, 78, rue du General-Leclerc, 94275 Kremlin-Bicêtre cedex, France
| | - L Giammattei
- Service de neurochirurgie, AP-HP, hôpital Bicêtre, Le Kremlin-Bicêtre, 78, rue du General-Leclerc, 94275 Kremlin-Bicêtre cedex, France.
| | - A Ozanne
- Service de neuroradiologie interventionnelle, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, 78, rue du General-Leclerc, 94275 Kremlin-Bicêtre cedex, France
| | - M Messerer
- Service de neuroradiologie interventionnelle, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, 78, rue du General-Leclerc, 94275 Kremlin-Bicêtre cedex, France; Service de neurochirurgie, AP-HP, hôpital Bicêtre, Le Kremlin-Bicêtre, 78, rue du General-Leclerc, 94275 Kremlin-Bicêtre cedex, France
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29
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Supratentorial leptomeningeal hemangioblastoma resection after tumor embolization. FORMOSAN JOURNAL OF SURGERY 2016. [DOI: 10.1016/j.fjs.2016.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Sultan A, Hassan T, Aboul-Enein H, Mansour O, Ibrahim T. The value of preoperative embolization in large and giant solid cerebellar hemangioblastomas. Interv Neuroradiol 2016; 22:482-8. [PMID: 26934897 DOI: 10.1177/1591019916633244] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 01/25/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Solid cerebellar hemangioblastomas are highly vascular lesions and may cause catastrophic hemorrhage during excision. METHODS This retrospective study enrolled 10 patients (7 men and 3 women, with a mean age of 38.2 ± 12.5 years) with solid cerebellar hemangioblastomas. All patients had a solitary tumor and underwent surgical resection of the lesion through a suboccipital approach. The basic features, serial radiographic examinations, and operative records were analyzed. RESULTS The most common presenting symptoms were headache (100%), ataxia (100%), and long tract manifestations (60%). Three patients had experienced failed surgery previously due to massive intraoperative bleeding. Three patients were confirmed as having Von Hippel-Lindau disease. The average size of the tumor was 40.7 ± 8.7 mm in its maximal diameter (range 25-58 mm). Total endovascular occlusion obtained in six patients, near total occlusion in three patients, and incomplete occlusion in one patient. Nine (90.0%) patients underwent gross total resection and one (10.0%) underwent partial resection. After the primary surgery, eight (80.0%) patients experienced improvement in their symptoms, two (20.0%) maintained their pre-treatment status, and none showed neurological deterioration following tumor resection. Blood loss during surgery after embolization was minimal and controllable. CONCLUSION Preoperative embolization improves safety and efficacy of the microsurgical excision of such tightly located very vascular tumors. Embolization changes the concept of this lesion surgery into piecemeal removal rather than a total mass extraction technique. Liquid agents are superior to particles in obliteration of such lesions.
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Affiliation(s)
- Ahmed Sultan
- Department of Neurosurgery, Alexandria University School of Medicine, Egypt The Research Center of Computational Neurovascular Biomechanics, Somoha University Hospital, Alexandria, Egypt
| | - Tamer Hassan
- Department of Neurosurgery, Alexandria University School of Medicine, Egypt The Research Center of Computational Neurovascular Biomechanics, Somoha University Hospital, Alexandria, Egypt
| | - Hisham Aboul-Enein
- Department of Neurosurgery, Alexandria University School of Medicine, Egypt
| | - Osama Mansour
- The Research Center of Computational Neurovascular Biomechanics, Somoha University Hospital, Alexandria, Egypt Department of Interventional Neurology, Alexandria University School of Medicine, Egypt
| | - Tamer Ibrahim
- Department of Neurosurgery, Alexandria University School of Medicine, Egypt The Research Center of Computational Neurovascular Biomechanics, Somoha University Hospital, Alexandria, Egypt
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Samartzis D, Gillis CC, Shih P, O'Toole JE, Fessler RG. Intramedullary Spinal Cord Tumors: Part II-Management Options and Outcomes. Global Spine J 2016; 6:176-85. [PMID: 26933620 PMCID: PMC4771497 DOI: 10.1055/s-0035-1550086] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 02/09/2015] [Indexed: 12/30/2022] Open
Abstract
Study Design Broad narrative review. Objectives Intramedullary spinal cord tumors (IMSCT) are uncommon lesions that can affect any age group or sex. However, numerous IMSCT exist and the clinical course of each tumor varies. The following article addresses the various management options and outcomes in patients with IMSCT. Methods An extensive review of the peer-reviewed literature was performed, addressing management options and clinical outcomes of patients with IMSCT. Results Early diagnosis and intervention are essential to obtain optimal functional outcome. Each IMSCT have specific imaging characteristics, which help in the clinical decision-making and prognostication. A comprehension of the tumor pathology and the clinical course associated with each tumor can allow for the proper surgical and nonsurgical management of these tumors, and reduce any associated morbidity and mortality. Recent advances in the operative management of such lesions have increased the success rate of tumor removal while minimizing iatrogenic-related trauma to the patient and, in tandem, improving patient outcomes. Conclusions Awareness and understanding of IMSCT is imperative to design proper management and obtain optimal patient outcomes. Meticulous operative technique and the use of surgical adjuncts are essential to accomplish proper tumor removal, diminish the risk of recurrence, and preserve neurologic function. Operative management of IMSCT should be individualized and based on tumor type, location, and dimensional extensions. To assist with preoperative and intraoperative decision-making, a general algorithm is provided.
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Affiliation(s)
- Dino Samartzis
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, SAR, China,Address for correspondence Dino Samartzis, DSc Department of Orthopaedics and Traumatology, The University of Hong Kong102 Pokfulam Road, Professorial Block, 5th Floor, Pokfulam, Hong Kong, SARChina
| | - Christopher C. Gillis
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Patrick Shih
- The Neurological Brain and Spine Center, Houston, Texas, United States
| | - John E. O'Toole
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Richard G. Fessler
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States,Richard G. Fessler, MD, PhD Department of Neurosurgery, Rush University Medical CenterRush Professional Office Building, 1725 W. Harrison Street, Suite 855, Chicago, IL 60612United States
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Ampie L, Choy W, Khanna R, Smith ZA, Dahdaleh NS, Parsa AT, Bloch O. Role of preoperative embolization for intradural spinal hemangioblastomas. J Clin Neurosci 2015; 24:83-7. [PMID: 26585384 DOI: 10.1016/j.jocn.2015.09.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/18/2015] [Indexed: 11/30/2022]
Abstract
Spinal hemangioblastomas (HB) are relatively rare neoplasms with a high degree of vascularity. Therapy for symptomatic tumors involves total resection when possible. Due to the enriched blood supply of these neoplasms, there is a high risk of significant intraoperative blood loss, which can lead to perioperative complications. Preoperative embolization of HB has been suggested to reduce blood loss and operative morbidity, but its use remains controversial. Data on the risks and benefits of preoperative embolization for this tumor remains limited. We identified and analyzed all 29 reported cases of preoperative embolization of intradural spinal HB within the literature. There were 18 men and nine women, and patients ranged from 24 to 61 years of age. Mean tumor size was 3.5 cm. Cervical and thoracic location was most common, accounting for 48.3% and 20% of cases, respectively. Complications from embolization and surgery were minimal, with no deaths or permanent neurological morbidity. Minimal intraoperative bleeding and excellent rates of gross total resection were reported with preoperative embolization. However, outcomes from microsurgery alone from historical series have similarly reported excellent outcomes. While there is no established standard, preoperative embolization should be reserved for particularly high risk patients with risk of intraoperative bleeding.
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Affiliation(s)
- Leonel Ampie
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 2210, Chicago, IL 60611-2911, USA
| | - Winward Choy
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 2210, Chicago, IL 60611-2911, USA
| | - Ryan Khanna
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 2210, Chicago, IL 60611-2911, USA
| | - Zachary A Smith
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 2210, Chicago, IL 60611-2911, USA
| | - Nader S Dahdaleh
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 2210, Chicago, IL 60611-2911, USA
| | - Andrew T Parsa
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 2210, Chicago, IL 60611-2911, USA
| | - Orin Bloch
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 2210, Chicago, IL 60611-2911, USA.
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dos Santos MP, Zhang J, Ghinda D, Glikstein R, Agid R, Rodesch G, Tampieri D, terBrugge KG. Imaging diagnosis and the role of endovascular embolization treatment for vascular intraspinal tumors. Neurosurg Focus 2015; 39:E16. [DOI: 10.3171/2015.5.focus1514] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Intraspinal tumors comprise a large spectrum of neoplasms, including hemangioblastomas, paragangliomas, and meningiomas. These tumors have several common characteristic imaging features, such as highly vascular mass appearance in angiography, hypointense rim and serpentine flow voids in MRI, and intense enhancement after intravenous contrast administration. Due to their rich vascularity, these tumors represent a special challenge for surgical treatment. More recently, the surgical treatment of intraspinal vascular tumors has benefited from the combination of endovascular techniques used to better delineate these lesions and to promote preoperative reduction of volume and tissue blood flow. Endovascular embolization has been proven to be a safe procedure that facilitates the resection of these tumors; hence, it has been proposed as part of the standard of care in their management.
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Affiliation(s)
| | - Jingwen Zhang
- 1Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, and
- 2Department of Radiology, First Affiliated Hospital, Dalian Medical University, Dalian, Liaoning, China; and
| | - Diana Ghinda
- 3Department of Surgery, Division of Neurosurgery, University of Ottawa
| | - Rafael Glikstein
- 1Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, and
| | - Ronit Agid
- 4Department of Medical Imaging, University Health Network, University of Toronto, Ontario
| | - Georges Rodesch
- 5Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Foch, Suresnes, France
| | - Donatella Tampieri
- 6Montreal Neurological Institute, Departments of Radiology, Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Karel G. terBrugge
- 4Department of Medical Imaging, University Health Network, University of Toronto, Ontario
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Spinal nerve root haemangioblastoma associated with reactive polycythemia. Case Rep Radiol 2014; 2014:798620. [PMID: 25431722 PMCID: PMC4241257 DOI: 10.1155/2014/798620] [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: 08/12/2014] [Revised: 10/17/2014] [Accepted: 10/17/2014] [Indexed: 11/17/2022] Open
Abstract
Haemangioblastomas are uncommon tumours that usually occur in the cerebellum and, less commonly, in the intramedullary spinal cord. The extramedullary spinal canal is an uncommon location for these tumours. Also haemangioblastoma at this site is not known to be associated with polycythemia. We present the clinical, imaging, and histological findings of an adult patient with extramedullary spinal haemangioblastoma and reactive polycythemia. Radiography and computed tomography (CT) revealed a medium-sized tumour that most likely arose from an extramedullary spinal nerve root. This tumour appeared to be slow growing as evidenced by the accompanying well-defined bony resorption with a sclerotic rim and mild neural foraminal widening. Magnetic resonance imaging revealed prominent flow voids consistent with tumoural hypervascularity. CT-guided biopsy was performed. Although preoperative angiographic embolisation was technically successful, excessive intraoperative tumour bleeding necessitated tumour debulking rather than complete tumour resection. Histology of the resected specimen revealed haemangioblastoma. Seven months postoperatively, the patients back pain and polycythemia have resolved.
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Raygor KP, Rowland NC, Cooke DL, Solomon DA, Huang MC. Aneurysm of the posterior meningeal artery embedded within a dorsal exophytic medullary hemangioblastoma: surgical management and review of literature. J Cerebrovasc Endovasc Neurosurg 2014; 16:293-8. [PMID: 25340034 PMCID: PMC4205258 DOI: 10.7461/jcen.2014.16.3.293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/01/2014] [Accepted: 08/11/2014] [Indexed: 12/02/2022] Open
Abstract
Hemangioblastomas are World Health Organization (WHO) Grade I neoplasms of the hindbrain and spinal cord, whose management can be complicated by preoperative hemorrhage. We report on a case of a young female in extremis with posterior fossa hemorrhage following rupture of a fusiform posterior meningeal artery aneurysm embedded within a medullary hemangioblastoma. We discuss management options, including operative staging and embolization, and review similar cases of hemangioblastoma associated with aneurysm.
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Affiliation(s)
- Kunal P Raygor
- UCSF Center for Stroke and Cerebrovascular Disease, Department of Neurological Surgery, University of California, San Francisco, CA, United States
| | - Nathan C Rowland
- UCSF Center for Stroke and Cerebrovascular Disease, Department of Neurological Surgery, University of California, San Francisco, CA, United States
| | - Daniel L Cooke
- Neuro-Interventional Section, Department of Radiology, University of California, San Francisco, CA, United States
| | - David A Solomon
- Department of Pathology, University of California, San Francisco, CA, United States
| | - Michael C Huang
- UCSF Center for Stroke and Cerebrovascular Disease, Department of Neurological Surgery, University of California, San Francisco, CA, United States
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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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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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Sankaredja J, Brac B, Thines L, Baroncini M, Zairi F, Cardot-Bauters C, Lejeune JP. [Epidemiology, treatment and follow-up of central nervous system hemangioblastomas in von Hippel-Lindau disease]. Rev Neurol (Paris) 2014; 170:288-96. [PMID: 24680832 DOI: 10.1016/j.neurol.2013.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 12/07/2013] [Accepted: 12/20/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Central nervous system (CNS) hemangioblastomas (HGB) are rare vascular tumors. The goal of this study was to analyze their epidemiology, treatment and prognosis in association with von Hippel-Lindau (VHL) disease. METHODS We retrospectively reviewed a series of patients treated in our department for a CNS HGB with VHL disease between 1996 and 2008. We analyzed pre- and postoperative clinical and radiological characteristics, number of visceral lesions (fundoscopy, abdomino-pelvian CT, metanephrines), clinical course (modified Rankin Scale and McCormick scale) and late prognosis (Kaplan-Meier survival curves). RESULTS We studied 19 cases (sex-ratio 0.9, mean age 36). The mean time to diagnosis was 61days. The main symptom was intracranial hypertension for cerebellar lesions (7/15) and a sensitive-motor deficit for medulla oblongata (2/5) or spinal lesions (5/11). Preferred locations were cerebellum (15/31), often nodulo-cystic appearance, followed by spinal cord (11/31), frequently coming with adjacent syringomyelia. Multiple locations and visceral lesions were found in two-third of the cases. Surgical removal was complete in more than three-quarter of the cases. Mean follow-up duration was 9years. Postoperative mortality rate was 16%. In cerebellar and medulla oblongata locations together, final mRS was ≤1 in 17 of the 20 cases. In spinal cord locations, final McCormick score was ≤2 in all the cases. After delayed follow-up, about two-third of patients experienced recurrence or new progressive CNS lesions. CONCLUSION HGB are rare CNS tumors. VHL disease should be considered when an HGB is diagnosed before 30, is located at the spinal cord, comes with multiple other CNS lesions or with typical peripheral lesions. Microsurgical removal is the gold standard treatment and can offer good functional results.
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Affiliation(s)
- J Sankaredja
- Clinique de neurochirurgie, pôle des neurosciences et de l'appareil locomoteur, hôpital Roger-Salengro, CHRU de Lille, université Lille Nord-de-France, avenue du Pr-Émile-Laine, 59037 Lille cedex, France
| | - B Brac
- Faculté de médecine de Lille, université Lille 2 (Option Initiation à la Rédaction d'Article), 1, place de Verdun, 59000 Lille, France
| | - L Thines
- Clinique de neurochirurgie, pôle des neurosciences et de l'appareil locomoteur, hôpital Roger-Salengro, CHRU de Lille, université Lille Nord-de-France, avenue du Pr-Émile-Laine, 59037 Lille cedex, France; Faculté de médecine de Lille, université Lille 2 (Option Initiation à la Rédaction d'Article), 1, place de Verdun, 59000 Lille, France.
| | - M Baroncini
- Clinique de neurochirurgie, pôle des neurosciences et de l'appareil locomoteur, hôpital Roger-Salengro, CHRU de Lille, université Lille Nord-de-France, avenue du Pr-Émile-Laine, 59037 Lille cedex, France
| | - F Zairi
- Clinique de neurochirurgie, pôle des neurosciences et de l'appareil locomoteur, hôpital Roger-Salengro, CHRU de Lille, université Lille Nord-de-France, avenue du Pr-Émile-Laine, 59037 Lille cedex, France
| | - C Cardot-Bauters
- Service de médecine interne et d'endocrinologie, hôpital Huriez, CHRU de Lille, université Lille Nord-de-France, 1, place de Verdun, 59000 Lille, France
| | - J-P Lejeune
- Clinique de neurochirurgie, pôle des neurosciences et de l'appareil locomoteur, hôpital Roger-Salengro, CHRU de Lille, université Lille Nord-de-France, avenue du Pr-Émile-Laine, 59037 Lille cedex, France
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Shin GW, Jeong HW, Seo JH, Kim ST, Choo HJ, Lee SJ. Preoperative embolization of cerebellar hemangioblastoma with onyx: report of three cases. Neurointervention 2014; 9:45-9. [PMID: 24644530 PMCID: PMC3955822 DOI: 10.5469/neuroint.2014.9.1.45] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 11/14/2013] [Indexed: 11/25/2022] Open
Abstract
Hemangioblastoma is a benign and highly vascular tumor. Complete surgical resection of highly vascular tumor such as hemangioblastoma may be challenging due to excessive bleeding. Preoperative embolization of these lesions may decrease the intraoperative blood loss and facilitate excision. We report three cases of cerebellar hemangioblastomas that were embolized using Onyx.
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Affiliation(s)
- Gi Won Shin
- Department of Diagnostic Radiology, Busan Paik Hospital, Inje University, Busan, Korea
| | - Hae Woong Jeong
- Department of Diagnostic Radiology, Busan Paik Hospital, Inje University, Busan, Korea
| | - Jeong Hwa Seo
- Department of Neurology, Busan Paik Hospital, Inje University, Busan, Korea
| | - Sung Tae Kim
- Department of Neurosurgery, Busan Paik Hospital, Inje University, Busan, Korea
| | - Hye Jung Choo
- Department of Diagnostic Radiology, Busan Paik Hospital, Inje University, Busan, Korea
| | - Sun Joo Lee
- Department of Diagnostic Radiology, Busan Paik Hospital, Inje University, Busan, Korea
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Akiyama T, Yoshida K, Horiguchi T, Kawase T. Management of Hemangiopericytoma. TUMORS OF THE CENTRAL NERVOUS SYSTEM 2014. [DOI: 10.1007/978-94-007-7602-9_4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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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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Nationwide survey of the nature and risk factors of complications in embolization of meningiomas and other intracranial tumors: Japanese Registry of NeuroEndovascular Therapy 2 (JR-NET2). Neuroradiology 2013; 56:139-44. [PMID: 24240580 DOI: 10.1007/s00234-013-1300-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 11/02/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Embolization of intracranial tumor is widely performed in Japan, mainly before neurosurgical resection. A retrospective, multicenter, observational study in Japan was conducted to clarify the nature, frequency, and risk factors of complications in intracranial tumor embolization. METHODS Patients were derived from the Japanese Registry of NeuroEndovascular Therapy 2 (JR-NET2). A total of 20,854 patients were enrolled in JR-NET2, of which 1,018 patients (4.88 %) with intracranial tumors underwent embolization. The primary end point was the proportion of patients with a modified Rankin scale (mRS) score of 0-2 (independency) at 30 days. The secondary end point was the occurrence of complications related to the procedures. The risk factors of the occurrence of complications were studied. RESULTS The proportion of patients with mRS scores ≤2 at 30 days after procedure was 91.3 %. Complications occurred in 15 of the 1,012 patients (1.48 %). Multivariate analysis showed that embolization for tumors other than meningioma (OR, 4.626; 95 % CI, 1.347-14.59; p = 0.0105) was significantly associated with the development of complications. CONCLUSION The frequency of complications after intracranial tumor embolization was relatively low in this large Japanese cohort. Embolization for tumors other than meningioma was the only significant risk factor for the occurrence of complications.
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Liu AH, Peng TM, Wu Z, Xiao XR, Jiang CH, Wu ZX, Li YX. Clinical effectiveness of preoperative embolization for cerebellar hemangioblastoma. Asian Pac J Cancer Prev 2013; 14:5179-83. [PMID: 24175797 DOI: 10.7314/apjcp.2013.14.9.5179] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The cerebellar hemangioblastoma (CHB) has an abundant blood supply and deep anatomical location. Complete surgical resection is generally very difficult. This study investigated the safety and effectiveness of preoperative embolization followed by surgical resection of CHB in a large cohort of patients. A database of 125 CHB patients with surgical resection in Beijing Tiantan Hospital between July 2006 and July 2012 was reviewed. Of those, 46 cases (experimental group) received preoperative embolization, 79 cases (control group) underwent surgery without embolization. Patient demographics, tumor size, duration of surgery, blood loss, blood transfusion, complications and follow-up results were collected and analyzed retrospectively. In the experimental group, the Kamofsky score (KS) was 80-100 in 40 cases (86.9%), 40-70 in 4 cases (8.7%), and below 40 in 2 cases (4.3%). Among 31 cases with follow-up, KS was 80-100 in 27 cases (87.1%), 40-70 in 2 cases (6.5%), and 0 in 2 cases (6.5%). In control group, KS was 80 -100 in 65 cases (82.2%), 40-70 in 6 cases (7.6%), 10-30 in 3 cases (3.8%), and 0 in 3 cases (3.8%). Among 53 cases with follow-up, KS was 80-100 in 44 cases (83.0%), 40-70 in 4 cases (7.5%), 10-30 in 1 case (1.9%), and 0 in 4 cases (7.5%). There were statistically significant differences between the experimental and control groups in tumor size, duration of surgery, amount of intraoperative blood loss and transfusion (p <0.01). However, complications (p = 0.31) and follow-up results (p = 0.76) showed no significant differences between groups. Selective preoperative embolization of those CHB patients with richer blood supply, higher hemorrhage risk, is safe and effective, and is a reliable adjuvant therapy for complete surgical resection of CHB.
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Affiliation(s)
- Ai-Hua Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China E-mail : ,
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Wu P, Liang C, Wang Y, Guo Z, Li B, Qiu B, Li X, Wen Z, Pan Q. Microneurosurgery in combination with endovascular embolisation in the treatment of solid haemangioblastoma in the dorsal medulla oblongata. Clin Neurol Neurosurg 2012; 115:651-7. [PMID: 22906819 DOI: 10.1016/j.clineuro.2012.07.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 07/08/2012] [Accepted: 07/15/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the treatment of solid haemangioblastomas in the dorsal medulla oblongata using microneurosurgery in combination with endovascular embolisation. METHODS Clinical data from 11 patients with solid haemangioblastomas in the dorsal medulla oblongata who were treated with endovascular embolisation followed by microneurosurgery were analysed retrospectively. Clinical results were evaluated using the modified Rankin scale. The patients were preoperatively evaluated by neuroimaging methods such as magnetic resonance imaging (MRI), contrast MRI and digital subtraction angiography (DSA). General anaesthesia was induced, the patients were tracheally intubated, and the abnormal vessels were embolised. Surgery to resect the haemangioblastoma was conducted after the blood-clotting index returned to normal levels (generally one month after the interventional treatment). RESULTS Embolisation was accomplished in all 11 patients. DSA analysis revealed that most of the tumour vessels and tumour stains disappeared without any complications. The haemangioblastomas were completely resected. None of the patients received blood transfusion or died during surgery. The neurological deficit was reduced or eliminated in 10 patients, but 1 patient died after experiencing an acute myocardial infarction on the tenth postoperative day. No recurrence occurred during follow-up in patients who underwent total tumour resection. Postoperative grades using the modified Rankin scale were improved in all 10 patients. However, several complications occurred, including communicating hydrocephalus, incision infection, pneumonia and cerebrospinal fluid leakage from the incision. Notably, normal perfusion pressure breakthrough (NPPB) did not develop during or after endovascular embolisation or surgery. CONCLUSION Preoperative endovascular embolisation is a safe and effective adjunct treatment. Employing this treatment, solid haemangioblastomas in the dorsal medulla oblongata can be safely and completely resected.
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Affiliation(s)
- Pengfei Wu
- Department of Neurosurgery, the First Affiliated Hospital, China Medical University, 155 Nan Jing Street, He Ping District, Shenyang, Liaoning 110001, China
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Wind JJ, Lonser RR. Management of von Hippel-Lindau disease-associated CNS lesions. Expert Rev Neurother 2012; 11:1433-41. [PMID: 21955200 DOI: 10.1586/ern.11.124] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Patients with von Hippel-Lindau disease (VHL) often harbor significant disease burden within the CNS, specifically craniospinal-axis hemangioblastomas and endolymphatic sac tumors (ELSTs). The majority (60-80%) of patients with VHL harbor hemangioblastomas, and 10-15% will develop ELSTs. Advances in the understanding of the natural history and outcomes associated with the surgical management of VHL-associated tumors have led to improved management of patients with VHL. Optimizing indications for surgical intervention and refining of surgical techniques for these lesions can reduce patient morbidity associated with the management of this syndrome. In this article, we review the various aspects of perioperative management of patients with VHL, surgical indications and general operative principles for the management of hemangioblastomas and ELSTs, and outcomes associated with the surgical treatment of these tumors.
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Affiliation(s)
- Joshua J Wind
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
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Harati A, Satopää J, Mahler L, Billon-Grand R, Elsharkawy A, Niemelä M, Hernesniemi J. Early microsurgical treatment for spinal hemangioblastomas improves outcome in patients with von Hippel-Lindau disease. Surg Neurol Int 2012; 3:6. [PMID: 22347675 PMCID: PMC3279991 DOI: 10.4103/2152-7806.92170] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 12/08/2011] [Indexed: 12/04/2022] Open
Abstract
Background: Spinal hemangioblastomas (HB) are rare, histologically benign, highly vascularized tumors often associated with von Hippel–Lindau (VHL) disease. The aim of the current study is to demonstrate the benefit of early surgical resection of large spinal HBs in selected asymptomatic patients with VHL. Methods: Seventeen patients underwent microsurgical resection of 20 spinal HBs at the Department of Neurosurgery at Helsinki University Central Hospital (HUCH). Thirteen tumors were in the cervical spine, five in thoracic and one patient had two lumbar lesions. MRI tumor showed an associated syrinx in 16 patients (94%). Tumor volume ranged from 27 to 2730 mm3. Out of 17 patients, 11 (65%) tested positive for VHL in mutation analysis. Five of these patients with tumors ranging from 55 to 720 mm3 were treated prophylactically. Results: Complete tumor resection was performed in 16 patients (94%) who were followed up for a median of 57 months (range 2–165 months). No patient had neurological decline on long-term follow-up. Among the patients with VHL, five patients with preoperative sensorimotor deficits showed improvement of their symptoms but never regained full function. One patient who presented with tetraplegia remained the same. Otherwise, all five patients with prophylactic surgery remained neurologically intact. Conclusion: Although documented growth on serial MRIs and the need for pathological diagnosis have been suggested as indications for surgery in otherwise asymptomatic patients, our series showed that a potentially larger group of asymptomatic patients with spinal HB associated with VHL would benefit from microsurgical resection. Long-term results of the surgical management of spinal HB are generally favorable. Our results suggest staging and early treatment for spinal HB larger than 55 mm3, especially in patients with VHL. Small spinal HBs may be followed up.
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Affiliation(s)
- Ali Harati
- Department of Neurosurgical, Helsinki University Central Hospital (HUCH), Helsinki, Finland
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Preoperative liquid embolization of cerebeller hemangioblastomas using N-butyl cyanoacrylate. Neuroradiology 2011; 54:981-8. [PMID: 22179658 DOI: 10.1007/s00234-011-0985-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 11/24/2011] [Indexed: 10/14/2022]
Abstract
INTRODUCTION We aim to present and discuss clinical outcomes of preoperative liquid embolization of hemangioblastomas (HB) using N-butyl cyanoacrylate (NBCA). METHODS From 1999 through 2010, 19 patients presenting with symptoms of vertigo and/or headaches were diagnosed with HB based on preoperative magnetic resonance imaging and cerebral angiographic findings at our institution. Preoperative embolization with NBCA was performed on tumors in 10 of 21 operations for 19 patients. For each of these patients, the lesion was pathologically confirmed as HB. RESULTS Embolization had a favorable outcome in all patients. No permanent neurological complications were observed after preoperative embolization using NBCA. However, thalamic infarction and minor hemorrhage were observed in two patients with cerebellar HB. CONCLUSION The authors recommend NBCA as an embolization material for large cerebellar HB.
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Tubbs RS, Nguyen HS, Shoja MM, Benninger B, Loukas M, Cohen-Gadol AA. The medial tentorial artery of Bernasconi-Cassinari: a comprehensive review of its anatomy and neurosurgical importance. Acta Neurochir (Wien) 2011; 153:2485-90. [PMID: 21997380 DOI: 10.1007/s00701-011-1195-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 09/27/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE The medial tentorial artery (MTA) of Bernasconi-Cassinari has been associated with many neurosurgical pathologies, including tentorial and petroclival meningiomas, dural arteriovenous fistulae, hemangioblastomas, moyamoya disease, arteriovenous malformations, trigeminal neuromas, and malignant gliomas. This vessel may function as a source of collateral blood supply for the posterior circulation. Our goal was to elucidate the MTA by compiling information about it in one concise article for clinicians and neurosurgeons who need to know about the anatomy and clinical significance of this artery. METHODS We reviewed the medical literature for information dealing with the anatomy, pathology, and surgery of the MTA and its clinical implications. RESULTS Based on the literature, the MTA commonly arises from the cavernous segment of the internal carotid artery and at times, may provide important collateral blood flow to the posterior circulation. This vessel is roughly 2 cm long and has a wavy appearance on angiography. It is usually a single trunk and often supplies the oculomotor, trochlear, and abducens nerves. The MTA may be seen on normal angiography and may be involved in the blood supply of petroclival and tentorial meningiomas. CONCLUSIONS A thorough knowledge of its anatomy and variations is important to clinicians interpreting imaging and neurosurgeons operating in this region. Detailed knowledge of this vessel may shed light on therapeutic options regarding its associated pathologies.
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Seong Eom K, Won Kim D, Sung Choi S, Ha Choi K, Young Kim T. Preoperative embolization of a cerebellar haemangioblastoma using Onyx: case report and literature review. Neurol Neurochir Pol 2011; 45:292-6. [PMID: 21866486 DOI: 10.1016/s0028-3843(14)60082-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Haemangioblastoma is a slow-growing, highly vascular tumour and typically occurs in the cerebellum but can also occur in the brainstem and spinal cord. Because of their hypervascularity and location, cerebellar haemangioblastomas can be difficult to remove. The purpose of preoperative embolization of haemangioblastomas is to decrease the intraoperative blood loss and to facilitate excision. However, the safety and efficacy of this procedure remain controversial. Here, we report the case of a man with cerebellar haemangioblastoma who underwent preoperative embolization with Onyx. The tumour was completely removed with minimal tumour bleeding. There was no complication related to embolization.
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Affiliation(s)
- Ki Seong Eom
- Wonkwang University College of Medicine, Iksan, South Korea
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