Spinal Extradural Hemangioblastoma Roentgenographically Visualized with Diodrast at Operation and Successfully Removed

Abstract

Extradural hemangioblastomas of the spine appear to be relatively uncommon. Four instances of intraspinal hemangioblastoma were recorded by Elsberg (1) in a series of 253 intraspinal tumors, and but one of these was extradural. So-called hemangiomas of the vertebrae resulting in cord compression are more common. In 1943 Blackford (2) collected 65 such cases from the literature, including one of his own. On the basis of his microscopic description of the tumor, Blackford's case, and probably some of the others as well, were most likely hemangioblastomas, that is, true neoplasms composed of growing angioblasts rather than hemangiomas (angiomas), which are vascular malformations. This distinction has been clearly made by Cushing and Bailey (3), although considerable confusion of terminology still exists with respect to these lesions. It is the purpose of this communication to relate an experience which, so far as is known to the writer, is unique. A pulsating hemangioblastoma arising from the spinal extradural space was encountered. At the time of the first operation the extent and the true nature of the lesion were not apparent, and it was considered inoperable. At a second operation, diodrast was injected into the mass and its extent as well as its main vessels of supply and drainage were clearly portrayed. It was then possible to extirpate the tumor and bring about functional recovery. Case Report History: H. N., a 42-year-old male, entered the Hospital June 15, 1946, complaining of numbness and coldness of the feet as well as weakness of the lower extremities of fifteen years' duration; urgency and frequency of urination with diminution of sexual potency for two years; occasional low back pain with radiation down the entire left lower limb. The symptoms were progressive. Examination: The general physical examination revealed a hard, freely movable mass, unattached to the skin, measuring 3.5 × 5.0 cm., located in the right anterior superior cervical triangle. The mass had first been noticed three years earlier and had increased in size gradually. A similar mass excised from the left cervical region sixteen years previously was diagnosed “tuberculous adenitis” on microscopic examination. The only other abnormal finding on general examination was the presence of hypertension (240/150). Neurological examination revealed the following abnormal findings: moderate weakness of both lower limbs, greater on the left; very active knee and ankle jerks with bilateral ankle clonus, absence of cremasteric reflexes, and bilateral extensor plantar responses; impairment in appreciation of pin-prick, hot and cold objects, and cotton-wool below the level of the groin on both sides, with a slight degree of sacral sparing of sensation; absence of appreciation of position sense of the great toes and vibration at the ankles.