Surgical strategy in spinal cord hemangioblastomas

Abstract

The complete removal of spinal cord hemangioblastomas must be the neurosurgeon's ultimate goal. Over about 18 years, we have operated on 25 patients with spinal cord hemangioblastomas. This article reports our experience, which has improved with the advent of radiological techniques, primarily magnetic resonance imaging (MRI). At present, MRI is the best and, in most cases, the only examination to perform. Preoperative neurophysiology and improvements related to our progressive surgical experience have helped us to find surgical solutions for lesions in difficult locations. Surgical approach primarily depends on the anatomical location of a lesion. We achieved complete surgical resection in all cases but one patient who had undergone two surgeries elsewhere and had also received radiation therapy. The surgical strategy for spinal cord hemangioblastoma is specific: complete “en bloc” removal of the tumor, avoiding bleeding during dissection, and maintaining all vessels coursing around the tumor but not feeding it. Associated cysts are cured by tumor removal, and shunting even the huge intramedullary cavities is unnecessary.