Biondi Alessandra, Ricciardi Giuseppe K, Faillot Tierry, Capelle Laurent, Van Effenterre Rémy, Chiras Jacques
Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris VI University, Paris, France.
AJNR Am J Neuroradiol. 2005 Apr;26(4):936-45.
Hemangioblastomas (HBs) are rare lesions accounting for 1-5% of all spinal cord tumors. Seventy-five percent of spinal HBs are intramedullary. Lesions of the conus medullaris and the cauda equina are uncommon, and the filum terminale location is very rare. HBs of the lower spinal region are highly vascular tumors requiring surgery that is potentially complicated by excessive bleeding. In the literature, there are few reports concerning preoperative embolization of HBs, and only few cases are reported in spinal location. Presurgical embolization of HBs located in the lower spinal region has not been described. Although lower spinal HBs are predominantly fed by the anterior spinal artery (ASA), embolization of these lesions is possible and can reduce tumor vascular supply, thus facilitating surgery. We report our experience in four rare cases of solitary HBs occurring in the lower spinal region.
Clinical charts and radiologic studies of four patients with a preoperatively embolized HB of the lower spinal region were retrospectively reviewed. The lesions were located in the conus medullaris in one case, at the level of the cauda equina in another, and in the filum terminale in two. In the conus medullaris case, the neoplasm was associated with a syrinx. In three patients, the HB was sporadic, while the patient with the HB of the cauda equina had Von Hippel-Lindau disease. Devascularization of the tumor was performed through the ASA in all cases and also through the posterior spinal artery in one by using non reabsorbable calibrated microspheres in three cases and polyvinyl alcohol particles in the other one.
Embolization caused no permanent complications, although one patient with a cauda equina HB mildly worsened after the endovascular procedure but recovered before surgery. At surgery, the tumor was completely removed in all cases. Blood loss was reported to be less than usually observed (100, 200, 200, and 400 mL). In addition, manipulation and removal of the tumor was reported to be easy in three of four tumors. Histologic examination confirmed the diagnosis. At 1-year postsurgical follow-up, two patient recovered completely from neurologic deficits, and two showed significant recovery. No tumor recurred during a follow-up period of 1-6 years (mean, 3.5 years).
Our results indicate that preoperative embolization of HBs of the lower spinal region is an useful procedure in aiding surgical resection of these highly vascular tumors. With a meticulous technique, embolization can be performed through the ASA.
血管母细胞瘤（HBs）是罕见病变，占所有脊髓肿瘤的1% - 5%。75%的脊髓HBs位于髓内。圆锥和马尾的病变不常见，终丝部位的病变则极为罕见。脊髓下部区域的HBs是高血管性肿瘤，手术时可能因出血过多而出现并发症。文献中关于HBs术前栓塞的报道较少，脊髓部位的报道仅有少数病例。尚未见关于脊髓下部区域HBs术前栓塞的描述。尽管脊髓下部的HBs主要由脊髓前动脉（ASA）供血，但对这些病变进行栓塞是可行的，且可减少肿瘤血供，从而便于手术。我们报告4例发生于脊髓下部区域的罕见孤立性HBs的治疗经验。
回顾性分析4例术前接受脊髓下部区域HBs栓塞治疗患者的临床病历和影像学检查资料。病变1例位于圆锥，1例位于马尾水平，2例位于终丝。圆锥病变的患者合并脊髓空洞症。3例患者的HBs为散发性，马尾HBs患者患有冯·希佩尔 - 林道病。所有病例均通过ASA进行肿瘤去血管化，1例还通过脊髓后动脉进行了去血管化，3例使用不可吸收的校准微球，另1例使用聚乙烯醇颗粒。
栓塞未引起永久性并发症，尽管1例马尾HBs患者在血管内操作后病情轻度恶化，但术前恢复。手术时，所有病例的肿瘤均被完全切除。报告的失血量少于通常所见（分别为100、200、200和400 mL）。此外，4例肿瘤中有3例报告称肿瘤的操作和切除较为容易。组织学检查确诊。术后1年随访时，2例患者神经功能缺损完全恢复，2例有明显恢复。在1 - 6年（平均3.5年）的随访期内无肿瘤复发。
我们的结果表明，脊髓下部区域HBs的术前栓塞是辅助切除这些高血管性肿瘤的有用方法。采用精细技术，可通过ASA进行栓塞。
