Combined Microsurgical and Endovascular Therapy of Intramedular Hemangioblastoma: a Case Report

Česká verzia

Authors: V. Přibáň ¹; J. Fiedler ¹; P. Řehoušek ¹; L. Štěrba ²; H. Štěpánková ³; A. Křepelová ⁴
Authors place of work: Neurochirurgické oddělení ¹; Radiodiagnostické oddělení ²; genetické oddělení Nemocnice České Budějovice ³; Ústav biologie a lékařské genetiky, FN Praha-Motol ⁴
Published in the journal: Cesk Slov Neurol N 2007; 70/103(5): 580-583
Category: Case Report

Summary

Authors present a case report of sporadic intramedullary hemangioblastoma with right C8 radicular symptomatology and mild spasticity of lower extremities. MRI preoperative diagnosis was: cervical spinal cord hemangioblastoma. There was visible „vascular rete“ on dorsal surface of spinal cord during the operation. Because of suspicion of arteriovenous malformation the operation has been stopped and spinal angiography was subsequently performed. Diagnosis of hemangioblastoma with dilated draining veins was proved. Two feeding arteries were embolized and subsequently after 24 hours tumour was radically removed. Patient is now without neurological deficit. Postoperative MRI showed no residual tumour, syrinx disappeared. Preoperative endovascular tumour embolization reduced risk of bleeding during the operation. In certain cases can embolization of feeding arteries help to improvement of operative result of sporadic spinal cord hemangioblastoma.

Key words:
Spinal cord hemangioblastoma – sporadic – von Hippel-Lindau disease – endovascular embolization

Zdroje

1. Yasargil MG, Antic J, Laciga R, dePreux J, Fiedeler RW, Boone SC et al. The microsurgical removal of intramedullary spinal hemangioblastomas. Report of twelve cases and review of the literature. Surg Neurol 1976; 3: 141-148.

2. Glenn GM, Linehan WM, Hosoe S, Latif F, Yao M, Choyke P et al. Screening for von Hippel-Lindau disease by DNA polymorphism analysis. JAMA 1992; 267: 1226-1231.

3. Lefranc F, Brotchi J. Surgical strategy in spinal cord hemangioblastomas. Operative Techniques in Neurosurgery. 2003; 6: 24-31.

4. Ho VB, Smirniotopoulos JG, Murphy FM et al. Radiologic-pathologic correlation: Hemangioblastoma. AJNR (Am J Neuroradiol) 1992; 13: 1343-1352.

5. Janda J, Mraček Z. Angioretikulom mozkového kmene. Současný výskyt arteriovenózní malformace epidurálního prostoru krční míchy. Cesk SlovNeurol N 1978; 6: 397-399.

6. McCormick PC, Torres R, Post KD, Stein BM. Intramedullary ependymoma of the spinal cord. J Neurosurg 1990; 72: 523-532.

7. Shulze F. Weiterer beitrage zur diagnose und operativen behandlung von geschwülsten der rückenmarkshäute und des rückenmarks. Deutsch Med Wochenschr 1912; 38: 1676-1679.

8. Lindau A. Studien über kleinhirncysten. Bau, Pathogenese und Beiziehunger zur Angiomatosis Retinae. Acta Pathol Microbiol Scan Suppl 1926; 1: 1-128.

9. Neumann HP, Eggert HR, Weigel K, Friedburg H, Wiestler OD, Schollmeyer P. Hemangioblastomas of the central nervous system. A 10-year study with special reference to von Hippel-Lindau syndrome. J Neurosurg 1989; 70: 24-30.

10.Plas J. Hemangioblastom CNS a von Hippel-Lindauova choroba. Zkušenosti s léčbou. Cesk Slov Neurol N 1995; 1: 28-32.

11. Smrčka M, Smrčka V. CNS hemangioblastoma: the role of Morbus von Hippel-Lindau. Brat Lék Listy 2000; 9: 503-506.

12. Seidl Z, Obenberger J, Viták T, Peterová V, Daneš J. Intramedulární míšní tumory a hydrosyringomyelie v obraze magnetické rezonance. Čes Radiol 1998; 6: 351-359.

13. Lonser RR, Weil RJ, Wanebo DeVroom HL, Oldfield EH. Surgical management of spinal cord hemangioblastomas in patients with von Hippel-Lindau disease. J Neurosurg 2003; 98: 106-116.

14. Martin NA, Khanna RK, Batzdorf U. Posterolateral cervical or thoracic approach with spinal cord rotation for vascular malformations or tumors of ventrolateral spinal cord. J Neurosurg 1995; 83: 254-261.

15. Iwasaki Y, Koyanagi I, Hida K. Anterior approach to intramedullary hemangioblastoma: case report. Neurosurgery 1999; 44: 655-657.

16. Pluta RM, Iuliano B, DeVroom RN, Tung Ngyen, Oldfield EH. Comparison of anterior and posterior approaches in the treatment of ventral spinal hemangioblastomas in patients with von Hippel-Lindau disease. J Neurosurg 2003; 98: 117-124.