Surgical management of intramedullary hemangioblastoma of the spinal cord

This is a study on 19 patients, who underwent complete excision of an intramedullary hemangioblastoma of the spinal cord during the period 1984-1997. The study was conducted to evaluate their functional outcome. Some peculiarities of their clinical presentation and surgical treatment are discussed as well. There were 12 males and 7 females whose age ranged from 16 to 69 years. Five of 6 patients were affected by Lindau's disease had multiple intramedullary tumors. The length of their history averaged 22.6 months. While pain was the most common complaint at presentation, 12 out of 19 patients had progressive sensorimotor deficits. A total of 22 operation was performed. One patient underwent resection of a minute tumor residue a few months after the first operation. In 2 patients with multiple tumors a second tumor, which became clinically relevant, was resected 17 and 36 months after the first operation. There was no mortality. One patients developed a wound infection which required secondary closure. The functional status of the patients registered at discharge was worse in 22.7%, unchanged in 59.1%, and improved in 18.2% of the patients. At follow-up (6-142 months), the status of 9.1% of the patients was still worse, in 50% was unchanged and in 40.9% better than the preoperative one. All but one patients had complete postoperative pain relief. The data support the concept that radical excision of intramedullary hemangioblastomas can be achieved at low levels of surgical mortality and morbidity. Symptomatic patients should undergo surgery before they develop extensive sensorimotor deficits. In patients with multiple lesions, tumors distant from the symptomatic one should not be tackled.