title: Surgical management of medullary hemangioblastoma. Report of 47 cases.
abstract: BACKGROUND
  Hemangioblastomas of the medulla are rare and seldom reported. Surgical resection of medullary hemangioblastomas is associated with high morbidity and mortality rates. We present a unique institutional experience over a 12-year period.
  
  
  METHODS
  Between 1987 to 1998, 47 hemangioblastomas were surgically resected and analyzed retrospectively. The follow-up ranged from 6 to 136 months with an average of 35 months.
  
  
  RESULTS
  Thirty-nine single hemangioblastomas were distributed in 3 anatomical areas: pontomedullary, medullary, and cervico-medullary. They were either focal intramedullary or dorsal exophytic. There were cyst formations in 97.4% of the single hemangioblastomas. The major feeding arteries and the tumor blush could be clearly visualized on angiogram, sometimes even on MRA. All medullary hemangioblastomas were radically removed. Postoperatively, 61.5% patients had clinical improvement, two patients' symptoms remained unchanged and 11 patients deteriorated; of the latter, 8 patients improved later with proper therapy, and 2 patients died.
  
  
  CONCLUSIONS
  Preoperative diagnosis of medullary hemangioblastoma is possible with MRI. With improved microsurgical technique and better understanding of the vascular pattern of the tumor, total surgical resection can be performed with <5% mortality. The surgical strategy is en bloc excision, as piecemeal resection can lead to uncontrollable hemorrhage. Removal of large solid hemangioblastomas may result in severe postoperative edema and/or hemorrhage in the medulla affecting the respiratory and vagal centers. Preoperative embolization through the posterior inferior cerebellar artery (PICA) can be helpful in this situation.
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Beijing 100050, People's Republic of China.
authors.forename: C
authors.initials: C
authors.lastname: Wang
authors.forename: J
authors.initials: J
authors.lastname: Zhang
authors.forename: A
authors.initials: A
authors.lastname: Liu
authors.forename: B
authors.initials: B
authors.lastname: Sun
mesh_terms: D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000098:blood supply / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D018325:Hemangioblastoma / Q000098:blood supply / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008526:Medulla Oblongata / Q000473:pathology; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome