Abstract
The prognostic factors for surgically removed spinal hemangioblastomas, the impact of VHL disease on outcome, and the role of intraoperative neuromonitoring are still not completely clear. The aim of this study was to review our experience with spinal hemangioblastomas in order to assess potential predictors of neurological outcome after surgery. All cases of spinal hemangioblastomas removed at two Italian academic institutions from 1985 to 2020 were reviewed. Data about clinical presentation and symptom duration, diagnosis of VHL, surgical approach, use of IONM, duration of hospital stay, follow-up, and modified McCormick grade before and after surgery were extracted. Sixty-one patients (31 F, 30M) underwent 69 surgeries to remove 74 spinal hemangioblastomas (37 cervical, 32 thoracic, 5 lumbar). Improvement was found in 32.3% of cases, neurological condition remained stable in 51.6% of cases, and deteriorated in 16.1% of patients. A worsening trend in VHL patients and an improvement trend in non-VHL patients were detected, despite the lack of statistical significance. Laminotomy and use of IONM were found to be associated with better outcome, although no association was found between surgery without IONM and worse outcome. In most cases, patients affected by spinal hemangioblastomas can expect a good long-term outcome. In our experience, laminotomy seems to be associated with better outcome compared to laminectomy. While its absence is not associated with worse outcome, IONM seems to be associated with a better neurological outcome. Our study suggests that the more impaired the preoperative neurological condition, the worse the outcome.
Highlights
Hemangioblastomas (HBs) of the central nervous system are histologically benign entities that can present with symptoms due to mass effect and compression of neural structures, especially in the presence of associated edema, cyst, or syrinx
We review our experience with 74 spinal HBs removed during 69 procedures in 61 patients (24 of them affected by von Hippel-Lindau (VHL) disease) and provide a thorough review of the pertinent literature
Based on the different time and surgeons, we divided the series into two groups: patients operated in the period 1985–2000 and those operated in the period 2000–2020
Summary
Hemangioblastomas (HBs) of the central nervous system are histologically benign entities that can present with symptoms due to mass effect and compression of neural structures, especially in the presence of associated edema, cyst, or syrinx. They are relatively uncommon, accounting for Department of Neurosciences, Biomedicine, and Movement Sciences, Institute of Neurosurgery, University of Verona, Polo Chirurgico “P. 2–6% of all spinal cord tumors and 2–15% of intramedullary tumors [1, 22, 39, 44, 46, 68] They are sporadic in 70–80% of cases, while 20–30% of them are associated to von Hippel-Lindau (VHL) disease [34]. Surgery with the aid of intraoperative neurophysiological monitoring (IONM) may be favored but its impact is debated
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
