Characterization of hemangioblastomas of spinal nerves.
OBJECTIVE
Hemangioblastoma is classified as a benign tumor of the central nervous system. Peripheral nervous system hemangioblastomas to date have been described only in a few case reports. Experience in treating patients with these rare lesions, which harbor diagnostic and therapeutic pitfalls, is limited.


METHODS
To characterize these lesions better, we reviewed our hemangioblastoma database for patients who underwent surgery for extradural hemangioblastoma of the spinal nerve.


RESULTS
Between 1983 and 2003, six patients underwent surgery for spinal nerve hemangioblastomas at our institution. These tumors occurred in 2% of all patients with hemangioblastomas of the central nervous system, or 6% of all patients with spinal hemangioblastomas. The occurrence did not differ in von Hippel-Lindau disease cases versus sporadic cases. Radiographically, the tumors easily could be mistaken for schwannomas or metastases; however, they did have some typical features. If a hemangioblastoma was not suspected primarily, profuse bleeding could complicate surgery. Most of the tumors arose from the dorsal sensory fascicles. The vascular supply was from extradural circulation. In general, the surgical outcome of these lesions was good, and permanent neurological deficit was rare. However, local recurrence was observed in three of six patients.


CONCLUSIONS
These tumors harbor diagnostic and therapeutic pitfalls. In general, the tumors are surgically more challenging, and clinically significant bleeding as well as local tumor recurrence is more common than in intradural hemangioblastomas, mostly because of the frequency of incorrect initial radiographic diagnosis. We suggest that because of the surgical consequences, hemangioblastoma should always be considered to be an important radiological differential diagnosis for nerve sheath tumors. Angiography can bring clarification to ambiguous cases.
Gläsker
Sven
S
Department of Neurosurgery, Albert-Ludwigs-University, Freiburg, Germany.
Berlis
Ansgar
A
Pagenstecher
Axel
A
Vougioukas
Vassilios I
VI
Van Velthoven
Vera
V
D000328:Adult; D016063:Blood Loss, Surgical; D003937:Diagnosis, Differential; D005260:Female; D018325:Hemangioblastoma / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D018324:Hemangioma, Capillary / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D006801:Humans; D015192:Infratentorial Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009442:Neurilemmoma / Q000175:diagnosis; D009463:Neuroma / Q000175:diagnosis; D010524:Peripheral Nervous System Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D011859:Radiography; D012189:Retrospective Studies; D013127:Spinal Nerves / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome; D006623:von Hippel-Lindau Disease / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology / Q000601:surgery