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CC BY-NC-ND 4.0 · J Neurol Surg A Cent Eur Neurosurg 2024; 85(06): 577-584
DOI: 10.1055/s-0043-1776707
Original Article

En Bloc Resection for Spinal Cord Hemangioblastomas: Surgical Technique and Clinical Outcomes

Xiaofeng Chen   *
1   Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
2   Institute of Brain Science, Harbin Medical University, Harbin, Heilongjiang, China
3   Institute of Neuroscience, Sino-Russian Medical Research Center, Harbin Medical University, Harbin, Heilongjiang, China
,
Hua Guo   *
1   Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
,
Jianli Zhang   *
4   Department of Neurology, Xiamen Fifth Hospital, Xiamen, Fujian, China
,
Junyi Ye
5   Department of Neurosurgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, Zhejiang, China
,
Shurong Wang
6   Department of Neurology, Hainan Medical University, Haikou, Hainan, China
,
Haiping Jiang
7   Department of Neurosurgery, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
,
Qingchun Mu
8   Department of Neurosurgery, The People's Hospital of Gaozhou of Guangdong Medical University, Maoming, Guangdong, China
,
Xiaoxiong Wang
1   Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
2   Institute of Brain Science, Harbin Medical University, Harbin, Heilongjiang, China
3   Institute of Neuroscience, Sino-Russian Medical Research Center, Harbin Medical University, Harbin, Heilongjiang, China
› Author Affiliations Funding This work was supported by the National Natural Science Foundation of China (81902554), Postdoctoral Science Foundation of Heilongjiang Province (LBH-Z19076 and LBHZ19190), Heilongjiang Welfare Fund Organization of Disabled Persons (HJ2022-1), Youth Foundation of the First Affiliated Hospital of Harbin Medical University (HYD2020YQ0018), Fujian Provincial Department of Science and Technology Guidance Program (No. 2022D031).
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Abstract

Background Spinal cord hemangioblastomas are rare benign and highly vascular tumors that develop either sporadically or as part of von Hippel–Lindau (VHL) disease. Generally, complete resection without significant neurologic deficit remains considerably challenging due to the risk of massive bleeding. The current study therefore aimed to describe en bloc resection of spinal cord hemangioblastomas according to the typical anatomical structures of peripheral lesions and evaluate the neurofunctional prognosis of this technique.

Methods A total of 39 spinal cord hemangioblastomas from a series of 19 patients who underwent en bloc resection were retrospectively analyzed. In all cases, clinical and radiologic characteristics, as well as surgical tenets, were retrospectively determined and analyzed. Short- and long-term outcomes were analyzed using the McCormick grade and Odom's criteria. Factors significantly associated with poor neurologic function after en bloc resection were also determined.

Results All 39 spinal cord hemangioblastomas, including 28 intramedullary, 2 intramedullary–extramedullary, and 9 extramedullary lesions, were located dorsally or dorsolaterally (100.0%). The most common lesion location was the thoracic segment (53.8%), with most of the lesions being accompanied by syringomyelia (94.7%). Long-term follow-up (mean: 103 ± 50.4 months) for prognosis determination revealed that 88.2% (15/17) of all cases had stable or improved neurofunctional outcomes according to the McCormick grade and Odom's criteria. Only one case with VHL disease developed recurrence 4 years after surgery. Additionally, statistical analysis showed that VHL disease was an independent prognostic factor associated with deteriorating neurologic function (p = 0.015).

Conclusions En bloc resection facilitated satisfactory long-term functional outcomes in patients with spinal cord hemangioblastomas. Given that VHL disease was identified as a predictor of poor long-term outcomes, regular long-term follow-up of patients with VHL-associated spinal cord hemangioblastoma seems necessary.

Keywords

spinal cord hemangioblastomas - en bloc resection - surgical technique - prognosis - retrospective analysis

Ethics approval

The study was approved by the ethics committee of the First Affiliated Hospital of Harbin Medical University. All procedures performed in studies involving human participants were in accordance with the ethical standards of the First Affiliated Hospital of Harbin Medical University and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


Author Contributions

X.C., H.G., and J.Z. contributed to the conceptualization, design, methodology, and writing and editing of the manuscript. S.W. and J.Y. were responsible for formal analysis and provided administrative, technical, or material support. X.W., H.J., and Q.M. contributed to the methodology and supervision of the study. They also contributed to writing, reviewing, editing, and revision of the manuscript.


* These authors contributed equally to this work.




Publication History

Received: 24 March 2023

Accepted: 31 August 2023

Article published online:
22 November 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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