Surgical Treatment of Intramedullary Hemangioblastomas: Current State of Problem (Review)

Long-term surgical outcomes and prognosis of cervical spinal hemangioblastomas

PURPOSE

Hemangioblastomas (HBs) occurring in the cervical spinal region are infrequently reported. Surgical resection of cervical HBs poses a significant challenge, and the long-term therapeutic outcomes remain unclear.

METHODS

A comprehensive retrospective analysis was conducted to review the treatment outcomes of patients with cervical HBs from 2011 to 2021. Patients with detailed preoperative clinical and radiological information, as well as follow-up data, were included in this study.

RESULTS

One hundred six adult patients were enrolled, with a mean age of 37.4 ± 15.6 years (range: 18-68 years), and a male predominance of 58.5 %. Thirty-two patients (30.2 %) had von Hippel-Lindau (VHL) disease. VHL-associated patients were younger (p = 0.023), had a shorter duration of symptoms (p = 0.004), and had smaller lesion size (p = 0.039) compared to the sporadic group. Fourteen patients (13.2 %) experienced immediate postoperative deterioration. During long-term follow-up, 35 patients (33.0 %) improved, 57 patients (53.8 %) remained stable. 8 patients (7.5 %) worsened compared to baseline, and 6 patients (5.7 %) died. A recurrent HBs (p = 0.027), ventral location (p = 0.046), and worsened immediately after surgery (p = 0.001) were statistically significant indicators for unfavorable outcomes in multivariate analysis.

CONCLUSION

Surgical resection of cervical spinal HBs can achieve favorable long-term outcomes in most cases, although neurological deterioration may occur immediately after surgery. Postoperative deficits occur in 13.2 % patients, and the incidence of respiratory insufficiency is relatively low. A recurrent HBs, ventral location, and worsened immediately after surgery were indicators for unfavorable outcomes.

Prognostic Factors of Spinal Intramedullary Hemangioblastoma : Analysis of Surgical Outcomes and Tumor Characteristics

OBJECTIVE

Spinal intramedullary hemangioblastoma is a rare and highly vascularized benign tumor. The characteristics of the tumor, its corresponding location, and surgical outcomes remain unknown. The purpose of this study was to identify risk factors and strategies for neurologic deterioration following hemangioblastoma surgery.

METHODS

A comprehensive retrospective analysis was undertaken to evaluate patients who underwent surgical intervention for intramedullary hemangioblastoma at our institution from 1993 to 2022. Patients with at least 1 year of follow-up data were included. The analysis covered patient demographics, pre- and post-operative modified McCormick scale (MMCS), tumor location, and tumor size.

RESULTS

This study included 25 cases. One-year after surgery, neurological deterioration was observed in five cases (20.0%), and neurological improvement was found in nine cases (36.0%). Five cases were ventrally located, and twelve cases were dorsally located. Ventrally located cases were larger in tumor axial size (p=0.029) than dorsal location tumors, resulting in poorer follow-up MMCS and a higher prevalence of von Hippel-Lindau syndrome (VHL) (p=0.042). Three of them were confirmed to be supplied by the anterior spinal artery. In the case of dorsally located cases, there was no neurologic deterioration.

CONCLUSION

In intramedullary spinal cord hemangioblastomas, cases located ventrally had a higher incidence of neurological deterioration following surgery than those located dorsally or in intramedullary extramedullary cases. Ventrally located hemangioblastomas were larger than those in other locations. They were mainly supplied by the anterior spinal artery in VHL patients.