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Shi W, Sun Y, Tang X. Intraspinal hemangioblastoma: A rare case report. Asian J Surg 2022; 45:2985-2986. [PMID: 35791988 DOI: 10.1016/j.asjsur.2022.06.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 06/23/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Wenfeng Shi
- Department of Orthopedic Surgery, Haining People's Hospital, Haining, Zhejiang, 314400, PR China.
| | - Yan Sun
- Department of Orthopedic Surgery, Haining People's Hospital, Haining, Zhejiang, 314400, PR China
| | - Xiongfei Tang
- Department of Orthopedic Surgery, Haining People's Hospital, Haining, Zhejiang, 314400, PR China
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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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Yoshino M, Nakatomi H, Kin T, Saito T, Shono N, Nomura S, Nakagawa D, Takayanagi S, Imai H, Oyama H, Saito N. Usefulness of high-resolution 3D multifusion medical imaging for preoperative planning in patients with posterior fossa hemangioblastoma: technical note. J Neurosurg 2017; 127:139-147. [DOI: 10.3171/2016.5.jns152646] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Successful resection of hemangioblastoma depends on preoperative assessment of the precise locations of feeding arteries and draining veins. Simultaneous 3D visualization of feeding arteries, draining veins, and surrounding structures is needed. The present study evaluated the usefulness of high-resolution 3D multifusion medical imaging (hr-3DMMI) for preoperative planning of hemangioblastoma. The hr-3DMMI combined MRI, MR angiography, thin-slice CT, and 3D rotated angiography. Surface rendering was mainly used for the creation of hr-3DMMI using multiple thresholds to create 3D models, and processing took approximately 3–5 hours. This hr-3DMMI technique was used in 5 patients for preoperative planning and the imaging findings were compared with the operative findings. Hr-3DMMI could simulate the whole 3D tumor as a unique sphere and show the precise penetration points of both feeding arteries and draining veins with the same spatial relationships as the original tumor. All feeding arteries and draining veins were found intraoperatively at the same position as estimated preoperatively, and were occluded as planned preoperatively. This hr-3DMMI technique could demonstrate the precise locations of feeding arteries and draining veins preoperatively and estimate the appropriate route for resection of the tumor. Hr-3DMMI is expected to be a very useful support tool for surgery of hemangioblastoma.
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Affiliation(s)
| | | | | | - Toki Saito
- 2Clinical Information Engineering, Graduate School of Medicine, The University of Tokyo, Japan
| | | | | | | | | | | | - Hiroshi Oyama
- 2Clinical Information Engineering, Graduate School of Medicine, The University of Tokyo, Japan
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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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Than KD, Sangala JR, Wang AC, Gandhi D, La Marca F, Park P. The current status and recent advances in high-resolution imaging of spinal vascular malformations. J Clin Neurosci 2012; 20:66-71. [PMID: 23117143 DOI: 10.1016/j.jocn.2012.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 05/12/2012] [Indexed: 10/27/2022]
Abstract
The management of spinal vascular malformations (SVM) has improved over the last four decades with the evolution of imaging, anesthesia, microsurgery, and endovascular techniques. Commonly used high-resolution imaging techniques include CT angiography, magnetic resonance angiography, and digital subtraction angiography. We review the advances that have been made in these imaging modalities and discuss their present role for imaging SVM, with the goal of assisting neurosurgeons in making judicious use of current imaging techniques to develop the most effective management strategies for these complex lesions.
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Affiliation(s)
- Khoi D Than
- Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, MI 48109-5338, 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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Hwang SW, Malek AM, Schapiro R, Wu JK. Intraoperative use of indocyanine green fluorescence videography for resection of a spinal cord hemangioblastoma. Neurosurgery 2010; 67:ons300-3; discussion ons303. [PMID: 20679920 DOI: 10.1227/01.neu.0000383876.72704.7b] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Indocyanine green (ICG) fluorescence videography has been recently applied to the neurosurgical field, mostly in the management of cerebral aneurysms, but has had limited description in the subspecialty of spine or oncological neurosurgery. We describe a novel application of this previously defined surgical tool to assist in the resection of a residual spinal cord hemangioblastoma. CLINICAL PRESENTATION Our patient is a 49-year-old woman with a residual symptomatic cervical hemangioblastoma that was previously embolized and resected at another institution. After initial symptomatic improvement, she returned with progressive symptoms, increasing radiographic spinal cord edema, and a residual lesion at the level of C1. We resected the remaining tumor with the adjuvant use of ICG fluorescence videography. Intraoperative injection of ICG clearly identified a component of the tumor underlying adhesive, opaque arachnoid that was not visualized by direct microscopy. Immediate postresection ICG videography suggested a complete resection was achieved which was later corroborated by postoperative magnetic resonance imaging. CONCLUSION The adjuvant use of ICG videography is a useful surgical tool that permits greater visualization of the complete extent of the lesion, particularly in managing recurrent or residual lesions obscured by adhesions.
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Affiliation(s)
- Steven W Hwang
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA.
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Ishizaka K, Kudo K, Fujima N, Zaitsu Y, Yazu R, Tha KK, Terae S, Haacke EM, Sasaki M, Shirato H. Detection of normal spinal veins by using susceptibility-weighted imaging. J Magn Reson Imaging 2010; 31:32-8. [PMID: 20027570 DOI: 10.1002/jmri.21989] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate the visualization of the spinal veins using susceptibility-weighted imaging (SWI). MATERIALS AND METHODS A 1.5-T magnet equipped with a spine matrix coil was used. Axial SWI scans of 20 healthy volunteers were obtained with a three-dimensional fast low-angle shot (3D-FLASH) sequence. Maximum intensity projection (MIP) of the phase images were reconstructed and five MIP images (at the levels of T11, T11/12, T12, T12/L1, and L1) were selected for the evaluation. The anterior median vein (AMV), posterior median vein (PMV), anterior radiculomedullary vein (ARV), posterior radiculomedullary vein (PRV), and sulcal vein (SV) were evaluated using a 4-grade scale (0, none; 1, weak; 2, moderate; and 3, prominent). RESULTS The AMV was detected in all the subjects (100%). The detection rates of the other veins were lower: PMV, 65%; right ARV, 45%; left ARV, 15%; right PRV, 10%; left PRV, 30%; and SV, 0%. The average scores for AMV, PMV, right ARV, left ARV, right PRV, left PRV, and SV were 0.98, 0.24, 0.20, 0.08, 0.08, 0.14, and 0, respectively. CONCLUSION SWI of the spine is feasible. The extrinsic spinal veins can be visualized by SWI without using contrast materials.
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Affiliation(s)
- Kinya Ishizaka
- Department of Radiology, Hokkaido University Hospital, Sapporo, Japan
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Matsubara N, Miyachi S, Izumi T, Ohshima T, Tsurumi A, Hososhima O, Kinkori T, Yoshida J. Usefulness of three-dimensional digital subtraction angiography in endovascular treatment of a spinal dural arteriovenous fistula. J Neurosurg Spine 2008; 8:462-7. [PMID: 18447693 DOI: 10.3171/spi/2008/8/5/462] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The use of 3D digital subtraction (DS) angiography provides a better understanding of spinal vascular lesion architecture. The authors report on 2 cases involving a spinal dural arteriovenous fistula (DAVF) and demonstrate the usefulness of 3D DS angiography for endovascular treatment of these spinal DAVFs. In both cases, middle-aged male patients suffered from bilateral leg hypesthesia, gait disturbance, and urinary dysfunction several months before treatment. Spinal angiography revealed DAVFs that were fed by a radicular artery branching from the intercostal artery and draining veins proceeding superiorly along the perimedullary veins. Endovascular embolization was performed in both cases. Selective 3D DS angiography of the intercostal artery clearly demonstrated the tortuous course of the feeder and the relationship among the feeding artery, fistula point, and draining veins in each case. This information was very useful in selecting a working angle for manipulating the microcatheter and for glue injection. In addition, the maximum intensity projection image from rotational DS angiography data clearly showed the fistula point at the dural sleeve and feeder entering the spinal canal via the intervertebral foramen and the relationship with the bone structure. Successful obliteration of the fistulae was achieved in both cases. Selective spinal 3D DS angiography was very useful in understanding the complex spinal vascular architecture and in choosing the best working angle and therapeutic strategy for endovascular treatment of spinal DAVFs.
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Affiliation(s)
- Noriaki Matsubara
- Department of Neurosurgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan.
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