Cerebellar and spinal hemangioblastomas: evaluation with intraoperative gray-scale color Doppler flow US

Intraoperative gray-scale and color Doppler flow ultrasound (US) studies were performed in 12 patients with von Hippel-Lindau disease during surgical excision of hemangioblastomas. There were a total of 21 lesions: two were in the cerebellum and 19 were in the spinal cord. Twelve of the 19 spinal hemangioblastomas were hyperechoic to the spinal cord and thus were easily detected with gray-scale US. Color Doppler flow images provided improved delineation of all lesions compared with the images produced with standard gray-scale US. Seven of the 19 spinal lesions were detected only with color Doppler flow imaging because they were isoechoic to the normal spinal cord at gray-scale US. Color Doppler flow imaging enabled differentiation of the cysts and syrinx cavities associated with hemangioblastomas from dilated intraspinal vascular structures. In all cases, intraoperative color Doppler flow imaging facilitated the localization of hemangioblastomas during the neurosurgical procedure.