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Surgical resection of medulla oblongata hemangioblastomas: outcome and complications
Lorenzo Giammattei1,2, Mahmoud Messerer3,4, Nozar Aghakhani3
1Department of Neurosurgery, Bicêtre University Hospital, Le Kremlin-Bicêtre, France. lore1985nch@gmail.com.
Object:
The purpose of this study was to analyze the surgical outcome and complications of a single-center series of medulla oblongata (MO) hemangioblastomas.
Methods:
We retrospectively reviewed the medical charts of all medulla oblongata hemangioblastomas operated on at our institution between 1996 and 2015. All patients had a pre- and postoperative MRI and a minimum follow-up of 6 months. Patients were scored according to the Karnofsky Performance Scale (KPS) and McCormick Scale at the moment of admission, discharge and the last follow-up.
Results:
Thirty-one surgical procedures were performed on 27 patients (16 females and 11 males). The mean age was 33 years, and 93 % of patients had von Hippel Lindau (VHL) disease. Three patients experienced very complicated postoperative courses, with one case ending in the death of the patient. Two patients required tracheostomy. According to McCormick's classification, 7 (23 %) of the 31 operations resulted in aggravation and 23 (74 %) in no change. Considering the seven patients with aggravation at discharge, four patients (60 %) returned to their preoperative status, one (14 %) improved but remained below his preoperative McCormick grade and two (29 %) did not improve. At last follow-up, KPS was ameliorated in 53 %, stable in 40 % and worsened in 7 % of cases.
Conclusion:
Surgery of medulla oblongata hemangioblastomas is a challenging procedure characterized by an acceptable morbidity. Transient morbidity is not negligible even if the long-term outcome is in most cases favorable. A compromised neurological condition seems to be the best predictor of unfavorable outcome.
Insights
Surgery for medulla oblongata hemangioblastomas is complex but offers favorable long-term outcomes. While transient complications occur, patient outcomes improve over time, especially for those not severely neurologically impaired pre-surgery.
Area of Science:
- Neurosurgery
- Oncology
- Neurology
Background:
- Medulla oblongata (MO) hemangioblastomas are rare tumors.
- Surgical intervention is the primary treatment modality.
- Understanding surgical outcomes and complications is crucial for patient management.
Purpose of the Study:
- To analyze the surgical outcomes and complications associated with medulla oblongata hemangioblastomas.
- To evaluate the long-term functional status of patients following surgery.
- To identify predictors of surgical outcomes.
Main Methods:
- Retrospective review of 27 patients (31 procedures) operated on between 1996 and 2015.
- Pre- and postoperative MRI scans were obtained for all patients.
- Karnofsky Performance Scale (KPS) and McCormick Scale were used for functional assessment.
Main Results:
- 93% of patients had von Hippel Lindau (VHL) disease.
- 23% of operations resulted in neurological aggravation at discharge.
- Long-term follow-up showed KPS improvement in 53% of patients and stability in 40%.
Conclusions:
- Surgery for MO hemangioblastomas is challenging with acceptable morbidity.
- Transient morbidity is common, but long-term outcomes are generally favorable.
- Preoperative neurological status is a key predictor of surgical success.
