gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

Intramedullary hemangioblastomas: Timing of surgery, microsurgical technique, and follow-up in 21 patients

Intramedulläre Hämangioblastome: Op-Indikation, mikrochirurgische Technik und Verlaufskontrolle von 21 Patienten

Meeting Abstract

  • corresponding author A. Boström - Klinik für Neurochirurgie, Universitätsklinikum der RWTH Aachen
  • F-J. Hans - Klinik für Neurochirurgie, Universitätsklinikum der RWTH Aachen
  • P. Reinacher - Klinik für Neurochirurgie, Universitätsklinikum der RWTH Aachen
  • T. Krings - Klinik für Neurochirurgie, Universitätsklinikum der RWTH Aachen
  • J.M. Gilsbach - Klinik für Neurochirurgie, Universitätsklinikum der RWTH Aachen
  • M.H.T. Reinges - Klinik für Neurochirurgie, Universitätsklinikum der RWTH Aachen

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocSA.11.09

The electronic version of this article is the complete one and can be found online at:

Published: May 8, 2006

© 2006 Boström et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Hemangioblastomas are rare highly vascularized tumors of the central nervous system accounting for 1.5 - 2.5% of all spinal cord tumors. They occur in 20-30% of von Hippel-Lindau (VHL) disease and are often multiple in these cases. Because of the low incidence of these tumors, surgical experience is limited and, therefore,indications for the timing of surgery are controversial. The authors reviewed their data of 21 patients with respect to timing of surgery, microsurgical technique and follow-up.

Methods: Clinical records of 21 patients with intramedullary hemangioblastomas, who underwent first surgery in our department between 1990-2005, were reviewed. In 3 cases the tumors were localized in the medulla, 4 patients had a single tumor in the cervical spine (CS), 4 patients had multiple tumors in the cs and thoracic spine (ts), 8 in ts only, 1 in the conus-medullare region, 1 had multiple tumors located in the thoracic and lumbar spine. In 8 (38%) patients a VHL was associated. Follow-up was evaluated according to 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 by microsurgery through a posterior approach. Tumors were removed in the spinal cord through a partial hemilaminectomy, a hemilaminectomy or aa laminectomy,. INn the medulla oblongata (n=3)the tumors are approached through a suboccipital trepanation. The strategy of the microsurgical removal of the tumor was to coagulate the dominant arterial feeder first, then coagulate and shrink the tumor and, finally, coagulate the venous drainage. Only patients with new onset of or progressive neurological deficits or with tumor progress in the follow-ups were treated by surgery. Postoperatively, 15 patient remained neurologically stable, all were in McCormick grade I. 5 patients recovered to a better status: 4 from grade II to I and 1 from grade III to II. 1 patient showed a temporary worsening of his symptoms but recovered to a status that was better than the pre-operative status during follow-up. Only 1 complication with a CSF-fistula and 1 recurrence/incomplete removal.1 patient underwent surgery twice, as the tumor couldn`t be identified during the first surgery.

Conclusions: Following the above mentioned principles of microsurgical removal of spinal hemangioblastomas, surgery is possible with a low procedure-related morbidity and can be recommended in patients with progressive symptoms or tumor growth during follow-up.