Technical considerations for cervical spine hemangioblastoma resection: A 2-D operative video

Cervical hemangioblastomas are low-grade, benign tumors that arise sporadically or in association with von Hippel-Lindau disease. Despite slow growth, they can cause significant neurologic morbidity from direct cord compression, peritumoral edema, or syrinx formation. Microsurgical resection remains the standard of care.

This report describes a 26-year-old male with progressive cervical myelopathy in the setting of a hemorrhagic Cervical 2-Cervical 4 (C2-C4) intradural intramedullary lesion with associated syringomyelia and cord edema. Given the isolated lesion and progressive symptomatology, a C2-C4 laminectomy with midline dural opening and resection of the intradural intramedullary lesion was recommended. After a routine laminectomy was performed, intraoperative ultrasound confirmed tumor exposure. The dura and arachnoid were then individually incised and secured bilaterally with tack-up sutures. Resection of the hemangioblastoma began with circumferential dissection along the tumor-cord interface, mobilizing each side before cauterizing the dominant draining vein and removing the tumor en bloc to minimize the risk of massive hemorrhage. Following resection, the dura and pia were closed individually without expansile duraplasty. Pathology confirmed hemangioblastoma (World Health Organization Grade I).

The patient had an uncomplicated postoperative hospital course and recovery. At 2 weeks, he was at his neurologic baseline with mild balance issues and upper-extremity myelopathy. At 4 months, he demonstrated marked improvement in preoperative myelopathy symptoms with only mild intermittent posterior neck numbness and nocturnal shoulder pain. Patient consent was obtained. Institutional Review Board approval was not required, given the single-case observational video.