Efficacy analysis of microsurgery for brain stem solid hemangioblastomas

Abstract

Objective To investigate the efficacy of microsurgery of brain stem solid hemangioblastomas under the techniques of nerve electrophysiological monitoring and temporary occlusion of feeding artery. Methods The treatment effect of microsurgery in 56 patients with brain stem solid hemangioblastoma treated at the Department of Neurosurgery, West China Hospital, Sichuan University from January 2005 to December 2014 were analyzed retrospectively. Of the 56 patients, 46 were treated via posterior median suboccipital approach, and 10 were treated with microsurgical treatment via extended far-lateral approach. All patients performed temporary occlusion of suspected blood supply artery for assisted tumor resection under the brainstem somatosensory evoked potential and motor evoked potential monitoring. Results In 56 patients, the postoperative magnetic resonance examination confirmed that the tumors of 54 patients were resected totally, and 2 were resected neartotally. Two patients who were not resected totally stopped their operation because of electrophysiological monitoring showed significant changes, and accompanied by a significant decrease in heart rate during the introperative separation of tumors. The 56 patients were followed up for a mean of 25 months. During the follow-up period, preoperative neurological dysfunction of 45 patients was improved significantly, 9 patients did not have any improvement compared with before procedure, and 2 developed new neurological deficits. Two patients had tumor recurrence during the follow-up period. One of them the tumor was resected neartotally. The gene detection of the latter was identified as Lindau VonHippel (VHL) disease. Conclusion Nerve electrophysiological monitoring and temporary occlusion of blood supply artery may reduce the risk of microsurgical resection of brainstem solid hemangioblastoma, improve the total tumor resection rate, and significantly improve the prognosis of patients. Key words: Central nervous system neoplasms; Brain stem; Hemangioblastoma; Microsugery