gms | German Medical Science

125. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

22. - 25.04.2008, Berlin

Microsurgery for intramedullary hemangioblastomas: Surgical technique and outcome in 21 consecutive patients

Meeting Abstract

  • corresponding author A. Boström - Neurochirurgische Klinik, Medizinische Universität Bonn
  • F.J. Hans - Neurochirurgische Klinik, Universitätsklinikum (RWTH) Aachen
  • T. Krings - Abteilung für Neuroradiologie, Universitätsklinikum (RWTH) Aachen
  • J.M. Gilsbach - Neurochirurgische Klinik, Universitätsklinikum (RWTH) Aachen
  • M.H.T. Reinges - Neurochirurgische Klinik, Universitätsklinikum (RWTH) Aachen

Deutsche Gesellschaft für Chirurgie. 125. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 22.-25.04.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. Doc08dgch9469

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgch2008/08dgch210.shtml

Veröffentlicht: 16. April 2008

© 2008 Boström et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction: Hemangioblastomas are rare high vascular tumors of the central nervous system accounting 1,5% - 2,5% of all spinal cord tumors. They can occur in 20-30% as component tumors of von Hippel-Lindau (VHL) disease and are often multiple in these cases. Because of the low frequency of these tumors, surgical experience in many clinics is limited and therefor, different treatment modalities and indications for surgery are discussed controversial in the literature. The authors reviewed their data in 21 patients with respect to timing of surgery, microsurgical technique and follow-up.

Material and methods: The clinical records of 21 patients with intramedullary hemangioblastomas who underwent first surgery in our department between 1990 and 2005 are reviewed. In 3 cases the tumors were localized in the medulla, 4 patients had only one tumor in the cervical spine, 4 multiple in the cervical and thoracic spine, 8 in the thoracic spine only, 1 in the conus medullary region and 1 patient had multiple tumors with localization in the thoracic spine and in level S1. There was no dominant sex distribution and in 8 (38%) cases a VHL was associated. In 7 (87,5%) of these patients the neoplasms were multiple. The neurological follow-up was evaluated according to the the classification of McCormick.

Results: All tumors were diagnosed by magnetic resonance imaging and in all cases but one a DSA was performed. All patients were treated microsurgically through a posterior approach. The tumors were removed in the spinal cord through a partial hemilaminectomy (n=1), a hemilaminectomy (n=13), or laminectomy (n=4) and at the craniocervical junction (n=3) through a suboccipital craniotomy. The strategy of microsurgical removal of the tumor was to coagulate the dominant arterial feeders first, then coagulate and shrink the tumor, and finally, coagulate the venous drainage of the tumor. During follow-up after 6 months, 18 patients remained neurologically stable (17 in McCormick grade I and 1 in McCormick grade II) and 4 patients recovered to a better status (3 from grade III to II, 1 from grade II to I). There was 1 complication with a CSF fistula and 1 recurrence/incomplete removal.

Conclusion: Timing of surgery is difficult especially in multiple intramedullary hemangioblastomas. Operation should be performed in cases with progressive symptoms or progressive tumor growth in the follow-ups. Intraoperatively first the arteria feeders especially the dominant artery should be occluded to avoid major intra-operative bleeding and make resection save. Although theses tumors are intramedullary localized, by this technique a save removal with respect to patients clinical status and recurrence rate is possible.