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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Cumulative surgical morbidity in patients with multiple cerebellar and medullary hemangioblastomas

Meeting Abstract

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  • Christine Steiert - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Marie T. Krüger - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Cordula Annette Jilg - Universitätsklinikum Freiburg, Klinik für Urologie, Klinik für Urologie, Freiburg, Deutschland
  • Stefan Zschiedrich - Albert-Ludwigs-Universität Freiburg, Medizinische Klinik IV/ Abteilung Nephrologie, Universitätsklinikum, Freiburg, Deutschland
  • Jan-Helge Klingler - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Vera Van Velthoven - Universitair Ziekenhuis Brussel, Department of Neurosurgery, Brussels, Belgium
  • Sven Gläsker - Universitair Ziekenhuis Brussel, Department of Neurosurgery, Brussels, Belgium

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 059

doi: 10.3205/17dgnc622, urn:nbn:de:0183-17dgnc6225

Published: June 9, 2017

© 2017 Steiert et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Patients affected with von Hippel-Lindau disease frequently develop multiple hemangioblastomas of the central nervous system, predominantly of the cerebellum, brain stem and spinal cord. Timing of surgical intervention is difficult and depends largely on the anticipated surgical morbidity. However, data regarding surgical outcome after multiple cerebellar and medullary surgeries are scarce.

Methods: To investigate cumulative surgical morbidity in patients operated on multiple hemangioblastomas of the central nervous system and to deduce recommendations for treatment, we analyzed all patients with surgical treatment of at least two cerebellar and/or medullary hemangioblastomas at the University of Freiburg between 1996 and 2013. Pre- and postoperative functional grades were determined by Modified Ranking Scale (cerebellar surgeries) or by Modified McCormick Score (medullary surgeries).

Results: A total of 36 patients underwent surgeries for at least two cerebellar hemangioblastomas (12 patients), for at least two medullary hemangioblastomas (19 patients) or for at least two hemangioblastomas in both locations (5 patients). All together 48 cerebellar and 80 medullary procedures were performed. Regarding cerebellar hemangioblastomas, postoperative functional grades determined by Modified Ranking Scale improved after 9 and remained stable after 39 out of 48 performed surgeries without one case of deterioration. Regarding medullary hemangioblastomas, postoperative functional grades determined by Modified McCormick Score improved after 3, remained stable after 54 and deteriorated after 23 out of 80 performed surgeries. The severity of deterioration did not increase with the number of performed medullary surgeries.

Conclusion: Resection even of multiple cerebellar hemangioblastomas is not associated with cumulative morbidity. Although there is a certain surgical morbidity caused by medullary surgeries, yet its extent does not increase with the number of performed surgeries. Microsurgical removal of asymptomatic tumors with radiographic progression should also be considered in patients with multiple tumors and previous surgeries.