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59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

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Hemangioblastomas of the IV ventricle: surgical experience

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  • corresponding author V. Monte - Neuroscience Department, “Casa Sollievo Sofferenza” Hospital and Scientific Research Institute, S. Giovanni Rotondo, Italy
  • D. Catapano - Neuroscience Department, “Casa Sollievo Sofferenza” Hospital and Scientific Research Institute, S. Giovanni Rotondo, Italy
  • V. Carotenuto - Neuroscience Department, “Casa Sollievo Sofferenza” Hospital and Scientific Research Institute, S. Giovanni Rotondo, Italy
  • M. Zarrelli - Neuroscience Department, “Casa Sollievo Sofferenza” Hospital and Scientific Research Institute, S. Giovanni Rotondo, Italy
  • N. Icolaro - Neuroscience Department, “Casa Sollievo Sofferenza” Hospital and Scientific Research Institute, S. Giovanni Rotondo, Italy
  • C. De Bonis - Neuroscience Department, “Casa Sollievo Sofferenza” Hospital and Scientific Research Institute, S. Giovanni Rotondo, Italy
  • V. D’Angelo - Neuroscience Department, “Casa Sollievo Sofferenza” Hospital and Scientific Research Institute, S. Giovanni Rotondo, Italy

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocMO.02.08

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2008/08dgnc047.shtml

Published: May 30, 2008

© 2008 Monte et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: The surgical management of IV ventricle hemangioblastomas (HBs) is complex and related to the anatomical area, the vascular supply and the histological characteristics.

Methods: Between 1992-2006, 4 cases of IV ventricle's HBs were operated on in our dept. (mean age 30 y.o., range 22-36). These represent 17% of all HBs and 12,5% of all IV ventricle tumors. Mean follow-up is 7.5 yrs (range 4-12 yrs).

In 3 cases, presentation was an HICPS while in 1, with von Hippel-Lindau disease, detection was occasional.

All patients underwent an MRI study; in 2 a cerebral angiography was performed.

In 3 patients, the surgical removal was preceded by external ventricular drainage while in all a temporary cardiac pace-maker was placed.

Results: All HBs were highly solid nodules (diameter: 2.5-4 cm) with a vascular supply from the PICA (bilaterally in two cases) and perforating arteries. In 3 patients the origin of tumor was the floor of the IV ventricle, in one patient the choroid plexus. The removal of the tumor led to episodes of bradycardia with activation of two pace makers (bradycardia).

In all cases tumor removal was radical.

Three patients have had a good outcome without any neurological deficit. One patient needed intensive care because of bradycardia episodes and complications by peritoneal perforation of a duodenal ulcer. This patient showed right VII c.n. deficit at the discharge, which partially recovered at follow-up.

In all cases, postoperative imaging revealed radical resection with no recurrence evidence at follow-up.

Conclusions: IV ventricle's HBs are very challenging lesions because of their frequent ventricular floor attachment and extensive vascular supply. At removal minimal mobilization can also result in pronounced bradycardia (two of four reported cases). For this reason the authors regard a temporary cardiac pace-maker positioned to reduce the risk of cardiac arrest to be of primary importance as this allows a safer and wider lesion removal.