Microneurosurgery in combination with endovascular embolisation in the treatment of solid haemangioblastoma in the dorsal medulla oblongata.
OBJECTIVE
To investigate the treatment of solid haemangioblastomas in the dorsal medulla oblongata using microneurosurgery in combination with endovascular embolisation.


METHODS
Clinical data from 11 patients with solid haemangioblastomas in the dorsal medulla oblongata who were treated with endovascular embolisation followed by microneurosurgery were analysed retrospectively. Clinical results were evaluated using the modified Rankin scale. The patients were preoperatively evaluated by neuroimaging methods such as magnetic resonance imaging (MRI), contrast MRI and digital subtraction angiography (DSA). General anaesthesia was induced, the patients were tracheally intubated, and the abnormal vessels were embolised. Surgery to resect the haemangioblastoma was conducted after the blood-clotting index returned to normal levels (generally one month after the interventional treatment).


RESULTS
Embolisation was accomplished in all 11 patients. DSA analysis revealed that most of the tumour vessels and tumour stains disappeared without any complications. The haemangioblastomas were completely resected. None of the patients received blood transfusion or died during surgery. The neurological deficit was reduced or eliminated in 10 patients, but 1 patient died after experiencing an acute myocardial infarction on the tenth postoperative day. No recurrence occurred during follow-up in patients who underwent total tumour resection. Postoperative grades using the modified Rankin scale were improved in all 10 patients. However, several complications occurred, including communicating hydrocephalus, incision infection, pneumonia and cerebrospinal fluid leakage from the incision. Notably, normal perfusion pressure breakthrough (NPPB) did not develop during or after endovascular embolisation or surgery.


CONCLUSIONS
Preoperative endovascular embolisation is a safe and effective adjunct treatment. Employing this treatment, solid haemangioblastomas in the dorsal medulla oblongata can be safely and completely resected.
Department of Neurosurgery, the First Affiliated Hospital, China Medical University, 155 Nan Jing Street, He Ping District, Shenyang, Liaoning 110001, China.
Pengfei
P
Wu
Chuansheng
C
Liang
Yunjie
Y
Wang
Zongze
Z
Guo
Bo
B
Li
Bo
B
Qiu
Xinguo
X
Li
Zhifeng
Z
Wen
Qichen
Q
Pan
D000293:Adolescent; D000328:Adult; D000368:Aged; D020295:Brain Stem Neoplasms / Q000601:surgery*; D003131:Combined Modality Therapy; D038524:Diffusion Magnetic Resonance Imaging; D004621:Embolization, Therapeutic / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D018325:Hemangioblastoma / Q000601:surgery*; D006801:Humans; D019934:International Normalized Ratio; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008526:Medulla Oblongata / Q000601:surgery*; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D011517:Prothrombin Time; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult