Operative Management and Outcomes after Resection of Intramedullary Hemangioblastomas

Wednesday, February 21, 2024

Presenting Author(s)

Andrew M. Hersh, B.S.

Medical Student
John Hopkins Medical School
Baltimore, MD, US

Co-Author(s)

Aladine A. Elsamadicy, M.D.

Resident
Yale School of Medicine
New Haven, CT, US
Sheng-fu Larry Lo, M.D. (he/him/his)

Northwell Health Director of Spine Tumor Surgery
Northwell Health
Great Neck, NY, US
Daniel Lubelski, MD

Assistant Professor of Neurosurgery
Johns Hopkins University School of Medicine
Baltimore, MD, US
Zach Pennington, MD

Resident
Mayo Clinic Department of Neurologic Surgery
Rochester, Minnesota, United States
DS

Daniel Sciubba, M.D., M.B.A.

Senior vice president of Neurosurgery at Northwell Health
Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health
Great Neck, New York, United States

Disclosure(s):

Andrew M. Hersh, A.B.: No financial relationships to disclose

Introduction: Intramedullary hemangioblastomas are uncommon vascular tumors representing 2% of all spinal tumors and frequently associated with Von-Hippel-Lindau (VHL) syndrome. Postoperative outcomes have been infrequently reported due to their rarity. Therefore, we present our institutional experience with intramedullary hemangioblastomas over two decades.

Methods: All patients operated on for intramedullary hemangioblastomas at a comprehensive cancer center between May 2004 and May 2020 were retrospectively identified. Data on patient demographics, baseline neurological status, functional deficits, operative characteristics, and long-term outcomes were collected. Results were summarized using STATA.

Results: A total of 17 patients were identified, of which 5 (29%) had VHL, and a total of 22 operations were performed. Tumors were most common in the cervical (64%) followed by thoracic (37%) spine. The average preoperative modified McCormick scale was 2, with numbness (82%) and weakness (59%) being the most common preoperative deficits. All patients (100%) achieved a successful gross total resection, with dorsal nerve roots sacrificed in 2 patients and no losses of intraoperative neuromonitoring. The average blood loss was 259 mL, average operative time was 242 minutes, and average length of stay was 8 days. Seven patients (32%) awoke with new or worsening weakness postoperatively, with only 1 case of wound breakdown and 1 readmission for a cerebrospinal fluid leak. The modified McCormick scale improved 1 point in 4 patients (27%) with 3-month follow-up, with further improvements noted in 3 patients (27%) with 6-month follow-up.

Conclusion : Gross total resection is safe and feasible for patients with intramedullary hemangioblastomas. Despite transient worsening of weakness or numbness postoperatively, most patients exhibit long-term improvements. Future studies should consider the separate implications in decision making for patients with VHL.