[Diagnosis and surgical treatment of spinal hemangioblastoma]

Spinal hemangioblastoma is a rare tumor. Its incidence varies from 1.6 to 2.1% of primary spinal cord tumors. In this report, the authors described MRI (magnetic resonance imaging) of spinal hemangioblastoma and its surgical results. [MATERIALS AND METHODS] This series included 10 spinal hemangioblastomas studied with CT or MRI. There were 8 men and 2 women. The age ranged from 21 to 68 years, with a mean age of 45 years. 6 patients were preoperatively and postoperatively studied with a resistive 0.15 T system (Toshiba MRT 15A) or a superconductive 1.5 T system (GE Signa or Siemens Magnetom). The lesions were single in 8 out of 10 patients and multiple in 2. 10 spinal hemangioblastomas were located in intramedullary space and 2 in both intramedullary and extramedullary space. 8 out of 10 patients (80%) were associated with cyst. [RESULTS] (1) MRI In T1-weighted MR images after administration of Gd-DTPA, the solid component of the tumor enhanced brilliantly. The enhanced lesions contained serpiginous areas of signal void, reflecting vascular structures in 5 out of 6 cases. The intrinsic spinal cord signal was heterogenous with low intensity areas representing the associated cyst. The cyst appeared either isointensive to cerebrospinal fluid (CSF) or hyperintense relative to CSF and slightly hypointense relative to the spinal cord. The precise delineation of the tumor was impossible without enhancement. Noncontrast T1-weighted MR images displayed diffuse widening of the spinal cord. On T2-weighted MR images, all regions of the spinal cord enlargement increased in signal. (2) Postoperative results All 10 cases of spinal hemangioblastomas were totally removed with good postoperative results and the associated cysts were drained. The postoperative MRI showed the disappearance of the tumor and significant reduction in the size of the cyst. [CONCLUSION] (1) Gd-DTPA enhanced MRI was useful in defining and outlining the solid component of spinal hemangioblastoma. (2) The complete removal of the tumor with only drainage of the cyst was possible with good postoperative results.