Tags

Type your tag names separated by a space and hit enter

Hemangioblastomas of the lower spinal region: report of four cases with preoperative embolization and review of the literature.
AJNR Am J Neuroradiol. 2005 Apr; 26(4):936-45.AA

Abstract

BACKGROUND AND PURPOSE

Hemangioblastomas (HBs) are rare lesions accounting for 1-5% of all spinal cord tumors. Seventy-five percent of spinal HBs are intramedullary. Lesions of the conus medullaris and the cauda equina are uncommon, and the filum terminale location is very rare. HBs of the lower spinal region are highly vascular tumors requiring surgery that is potentially complicated by excessive bleeding. In the literature, there are few reports concerning preoperative embolization of HBs, and only few cases are reported in spinal location. Presurgical embolization of HBs located in the lower spinal region has not been described. Although lower spinal HBs are predominantly fed by the anterior spinal artery (ASA), embolization of these lesions is possible and can reduce tumor vascular supply, thus facilitating surgery. We report our experience in four rare cases of solitary HBs occurring in the lower spinal region.

METHODS

Clinical charts and radiologic studies of four patients with a preoperatively embolized HB of the lower spinal region were retrospectively reviewed. The lesions were located in the conus medullaris in one case, at the level of the cauda equina in another, and in the filum terminale in two. In the conus medullaris case, the neoplasm was associated with a syrinx. In three patients, the HB was sporadic, while the patient with the HB of the cauda equina had Von Hippel-Lindau disease. Devascularization of the tumor was performed through the ASA in all cases and also through the posterior spinal artery in one by using non reabsorbable calibrated microspheres in three cases and polyvinyl alcohol particles in the other one.

RESULTS

Embolization caused no permanent complications, although one patient with a cauda equina HB mildly worsened after the endovascular procedure but recovered before surgery. At surgery, the tumor was completely removed in all cases. Blood loss was reported to be less than usually observed (100, 200, 200, and 400 mL). In addition, manipulation and removal of the tumor was reported to be easy in three of four tumors. Histologic examination confirmed the diagnosis. At 1-year postsurgical follow-up, two patient recovered completely from neurologic deficits, and two showed significant recovery. No tumor recurred during a follow-up period of 1-6 years (mean, 3.5 years).

CONCLUSION

Our results indicate that preoperative embolization of HBs of the lower spinal region is an useful procedure in aiding surgical resection of these highly vascular tumors. With a meticulous technique, embolization can be performed through the ASA.

Authors+Show Affiliations

Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris VI University, Paris, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

15814949

Citation

Biondi, Alessandra, et al. "Hemangioblastomas of the Lower Spinal Region: Report of Four Cases With Preoperative Embolization and Review of the Literature." AJNR. American Journal of Neuroradiology, vol. 26, no. 4, 2005, pp. 936-45.
Biondi A, Ricciardi GK, Faillot T, et al. Hemangioblastomas of the lower spinal region: report of four cases with preoperative embolization and review of the literature. AJNR Am J Neuroradiol. 2005;26(4):936-45.
Biondi, A., Ricciardi, G. K., Faillot, T., Capelle, L., Van Effenterre, R., & Chiras, J. (2005). Hemangioblastomas of the lower spinal region: report of four cases with preoperative embolization and review of the literature. AJNR. American Journal of Neuroradiology, 26(4), 936-45.
Biondi A, et al. Hemangioblastomas of the Lower Spinal Region: Report of Four Cases With Preoperative Embolization and Review of the Literature. AJNR Am J Neuroradiol. 2005;26(4):936-45. PubMed PMID: 15814949.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hemangioblastomas of the lower spinal region: report of four cases with preoperative embolization and review of the literature. AU - Biondi,Alessandra, AU - Ricciardi,Giuseppe K, AU - Faillot,Tierry, AU - Capelle,Laurent, AU - Van Effenterre,Rémy, AU - Chiras,Jacques, PY - 2005/4/9/pubmed PY - 2006/1/28/medline PY - 2005/4/9/entrez SP - 936 EP - 45 JF - AJNR. American journal of neuroradiology JO - AJNR Am J Neuroradiol VL - 26 IS - 4 N2 - BACKGROUND AND PURPOSE: Hemangioblastomas (HBs) are rare lesions accounting for 1-5% of all spinal cord tumors. Seventy-five percent of spinal HBs are intramedullary. Lesions of the conus medullaris and the cauda equina are uncommon, and the filum terminale location is very rare. HBs of the lower spinal region are highly vascular tumors requiring surgery that is potentially complicated by excessive bleeding. In the literature, there are few reports concerning preoperative embolization of HBs, and only few cases are reported in spinal location. Presurgical embolization of HBs located in the lower spinal region has not been described. Although lower spinal HBs are predominantly fed by the anterior spinal artery (ASA), embolization of these lesions is possible and can reduce tumor vascular supply, thus facilitating surgery. We report our experience in four rare cases of solitary HBs occurring in the lower spinal region. METHODS: Clinical charts and radiologic studies of four patients with a preoperatively embolized HB of the lower spinal region were retrospectively reviewed. The lesions were located in the conus medullaris in one case, at the level of the cauda equina in another, and in the filum terminale in two. In the conus medullaris case, the neoplasm was associated with a syrinx. In three patients, the HB was sporadic, while the patient with the HB of the cauda equina had Von Hippel-Lindau disease. Devascularization of the tumor was performed through the ASA in all cases and also through the posterior spinal artery in one by using non reabsorbable calibrated microspheres in three cases and polyvinyl alcohol particles in the other one. RESULTS: Embolization caused no permanent complications, although one patient with a cauda equina HB mildly worsened after the endovascular procedure but recovered before surgery. At surgery, the tumor was completely removed in all cases. Blood loss was reported to be less than usually observed (100, 200, 200, and 400 mL). In addition, manipulation and removal of the tumor was reported to be easy in three of four tumors. Histologic examination confirmed the diagnosis. At 1-year postsurgical follow-up, two patient recovered completely from neurologic deficits, and two showed significant recovery. No tumor recurred during a follow-up period of 1-6 years (mean, 3.5 years). CONCLUSION: Our results indicate that preoperative embolization of HBs of the lower spinal region is an useful procedure in aiding surgical resection of these highly vascular tumors. With a meticulous technique, embolization can be performed through the ASA. SN - 0195-6108 UR - https://www.unboundmedicine.com/medline/citation/15814949/Hemangioblastomas_of_the_lower_spinal_region:_report_of_four_cases_with_preoperative_embolization_and_review_of_the_literature_ L2 - http://www.ajnr.org/cgi/pmidlookup?view=long&pmid=15814949 DB - PRIME DP - Unbound Medicine ER -