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Surgical treatment for hemangioblastomas in the medulla oblongata

  • Clinical Article
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Abstract

Purpose

The purpose of this study was to evaluate the outcome of surgical treatment of hemangioblastomas in the medulla oblongata.

Methods

Between January 2006 and December 2007, 18 patients who underwent surgery for hemangioblastomas in the medulla oblongata in the Neurosurgical Department of Huashan Hospital were retrospectively reviewed.

Result

The study population was 13 males and five females. The main symptoms were headache, cervical pain, and dizziness. All patients had preoperative and postoperative examination by MRI. There were five cystic tumors and 13 solid tumors. Tumor diameter ranged from 1 to 4.3 cm (mean, 2.6 cm). Complete tumor resection was achieved in all patients, but one patient died. Embolization was done in three patients. According to McCormick scale, postoperative condition was worse in one patient, unchanged in 14 patients, and improved in three patients. In follow-up assessments, no surviving patients remained in a worse condition. Compared with the preoperative condition, 11 patients were unchanged, and six patients exhibited improvement. Tumor recurrence was not observed during follow-up.

Conclusion

Surgery is the first-line treatment for symptomatic patients with hemangioblastomas in the medulla oblongata. Good results can be achieved for the cystic or small solid tumors. Large solid tumors remain a surgical challenge due to arteriovenous malformation-like vascularization. Preoperative embolization is useful for large solid tumors. For asymptomatic tumors, careful long-term observation or radiosurgery could be chosen.

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Authors and Affiliations

  1. Department of Neurosurgery, Huashan Hospital of Fudan University, 12# Wulumuqi Zhong Road, Shanghai, China, 200040

    Qi Wu Xu, Rong Xu, Zhuo Ying Du & Xiang Gao

Authors
  1. Qi Wu Xu
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  2. Rong Xu
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  3. Zhuo Ying Du
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  4. Xiang Gao
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Corresponding author

Correspondence to Xiang Gao.

Additional information

Comment

The authors show excellent results with surgical excision of medullary primary subpial hemangioblastomas. The important points that are highlighted for a successful surgical outcome include:

The tumors primarily chosen for surgery should have a predominant subpial component. Primary intramedullary lesions have a much poorer prognosis. Gentle coagulation of the tumor with adequate irrigation promotes tumor shrinkage and facilitates definition of its plane of cleavage from the brain stem. Piecemeal excision should generally be avoided. As in surgery for arteriovenous malformations, an attempt should be made to preserve the draining veins of the tumor until the majority of the tumor has been addressed. Even if piecemeal excision is mandated to limit the length of the exposing incision on the brain stem, the tumor may be coagulated until its consistency changes from a spongy to a fibrotic one. This limits bleeding from the tumor (when a piecemeal excision is being attempted) and prevents obliteration of the plane between the tumor and the neuraxis. In case a well-defined plane is not discernible between the tumor capsule and the brain stem (especially with recurrent lesions), leaving a small portion of the capsule is preferable to an aggressive attempt to achieve total excision as a long-term favorable outcome is anticipated even if a small portion of the tumor capsule remains in situ. Both embolization and tractography are useful adjuncts to achieve a good functional outcome. The patients must be meticulously monitored for their postoperative respiratory status and swallowing and gag reflexes as their impairment is the major cause of postoperative morbidity.

Sanjay Behari

Lucknow, India

Qi Wu Xu and Rong Xu contributed equally to this article.

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Xu, Q.W., Xu, R., Du, Z.Y. et al. Surgical treatment for hemangioblastomas in the medulla oblongata. Acta Neurochir 152, 1331–1335 (2010). https://doi.org/10.1007/s00701-010-0668-8

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  • DOI: https://doi.org/10.1007/s00701-010-0668-8

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