Efficacy of microsurgical treatment of medulla hemangioblastoma

Abstract

Objective To explore the microsurgical outcome of medulla hemangioblastomas. Methods A total of 88 cases of medulla hemangioblastoma underwent microsurgical treatment assisted with intraoperative neurophysiological monitoring at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University between June 2011 and June 2016, whose clinical data and surgical outcomes were retrospectively analyzed. Results Among the 88 patients of medulla hemangioblastoma, 38 cases were cyst and solid and the remaining ones were purely solid. Moreover, there were 70 cases with a single lesion and 18 cases with multiple lesions. The Von Hippel-Lindau syndrome was present in 18 (20.5%) patients. All dorsal medullary tumors underwent gross total resection (GTR). Three (3.4%) deaths occurred postoperatively due to pulmonary infection. Temporary pulmonary embolism occurred in one patient. Other complications were also documented including stress-related gastrointestinal bleeding in 3 cases, pneumonia in 24(27.3%) cases, hematoma in 5 cases, deep venous thrombosis (DVT) in 7 cases, cerebrospinal fluid (CSF) leakage in 4 cases and infection of central nervous system in 6 cases. Eighty-one patients were followed up for about 3-60 months. Dizziness, headache, nausea and vomiting were reported in 56 instances, all of which were improved to varying degrees within 6 months. Out of 17 cases with decreased muscle strength prior to operations, 11 recovered and the others remained the same. Among 15 cases who presented with the lower cranial nerve-related symptoms, 9 were improved but the other 6 were not. Tumor recurrence developed in 15(17.0%) patients postoperatively including 2 cases with local recurrence that occurred 4 years and 10 years post GTR, respectively, and underwent the second operation. There were 13 cases developing tumor recurrence in other regions and 10 out of them underwent the second operation. Three (3.4%) patients died during the follow-up. Conclusion Satisfactory clinical outcomes could be achieved through microsurgery assisted with intraoperative neurophysiological monitoring. Key words: Hemangioblastoma; Medulla oblongata; Microsurgery