Radiological characteristics of spinal hemangioblastomas in von Hippel Lindau disease as guidance in clinical interventions.
World Neurosurg 2022;
168:e67-e75. [PMID:
36126890 DOI:
10.1016/j.wneu.2022.09.011]
[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: 06/15/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/24/2022]
Abstract
Hemangioblastomas in the central nervous system (CNS) are the most common manifestation of Von Hippel-Lindau (VHL) disease. Because the growth rate of hemangioblastomas is unpredictable, regular follow-up is mandatory, focusing on clinical symptoms and imaging of the CNS. However, clinical symptoms may be subtle and non-specific, and data about the relationship between the radiological findings and clinical symptoms are sparse.
AIM OF THE STUDY
This study aims to evaluate if and how findings of magnetic resonance imaging (MRI) regarding spinal hemangioblastomas are associated with symptoms of VHL disease, with special attention to peritumoral edema and spinal cysts.
METHODS
Serial spinal MRI scans of 43 genetically or clinically established VHL patients with at least two years of follow-up were re-evaluated to examine the volume, growth rate, and location of spinal hemangioblastomas and the presence, size, and growth rate of peritumoral edema and cysts. Findings were compared with clinical symptoms using Fisher's exact test.
RESULTS
We observed a total of 77 spinal hemangioblastomas in 28 patients. Eight of the 28 patients showed peritumoral edema and spinal cysts, and one patient showed peritumoral edema without cyst formation; six of these nine patients showed clinical symptoms. Both peritumoral edema and spinal cysts were associated with clinical symptoms (P=0.023 and P=0.011, respectively).
CONCLUSION
The presence of peritumoral edema and/or spinal cysts shown on MRI in VHL-patients with spinal hemangioblastomas is associated with symptoms in more than half of the patients and may alert the clinician to intensify clinical and radiological surveillance.
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