title: Discrete or diffuse intramedullary tumor? Contrast-enhanced intraoperative ultrasound in a case of intramedullary cervicothoracic hemangioblastomas mimicking a diffuse infiltrative glioma: technical note and case report.
abstract: Hemangioblastomas are benign, highly vascularized intramedullary lesions that may also extend into the intradural space. Surgery represents the standard therapy, with the goal of obtaining complete resection even at the risk of neurological morbidity. MRI is the gold standard for diagnosis and assessment of intramedullary tumors. Nevertheless, sometimes MRI may not accurately differentiate between different types of intramedullary tumors, in particular if they are associated with syringes or intra- and peritumoral cysts. This could subsequently affect surgical strategies. Intraoperative ultrasound (ioUS) has become in the last few years a very useful tool for use during neurosurgical procedures. Various ioUS modalities such as B-mode and Doppler have been applied during neurosurgical procedures. On the other hand, the use of contrast-enhanced ultrasound (CEUS) is not yet well defined and standardized in this field. We report a case of a young patient harboring a cervicothoracic intramedullary tumor, for which the preoperative neuroradiologi-cal diagnosis was in favor of a diffuse astrocytoma with nodular components whereas ioUS demonstrated 3 distinct intramedullary nodules. CEUS showed highly vascularized lesions, compatible with hemangioblastomas. These findings, particularly those obtained with CEUS, allowed better definition of the lesions for diagnosis, enhanced understanding of the physiopathological aspects, and permitted the localization of all 3 nodules, thus limiting spinal cord manipulation and allowing complete resection of the lesions, with an uneventful postoperative neurological course. To the best of our knowledge, this is the first report of the use of intraoperative CEUS in a case of intramedullary hemangioblastoma.
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta";|University of Milan; and.
authors.forename: Ignazio G
authors.initials: IG
authors.lastname: Vetrano
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta";
authors.forename: Francesco
authors.initials: F
authors.lastname: Prada
authors.affiliation: University of Milan; and.|Department of Thoracic Surgery, Fondazione IRCCS Cà Granda - Ospedale Maggiore Policlinico, Milan, Italy; and.
authors.forename: Ilaria F
authors.initials: IF
authors.lastname: Nataloni
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta";
authors.forename: Massimiliano Del
authors.initials: MD
authors.lastname: Bene
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta";|Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Francesco
authors.initials: F
authors.lastname: Dimeco
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta";
authors.forename: Laura G
authors.initials: LG
authors.lastname: Valentini
mesh_terms: D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D003287:Contrast Media / Q000008:administration & dosage*; D003937:Diagnosis, Differential; D005910:Glioma / Q000175:diagnosis; D018325:Hemangioblastoma / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D016343:Monitoring, Intraoperative / Q000295:instrumentation; D019635:Neurosurgical Procedures; D013120:Spinal Cord Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D003287:Contrast Media
keywords: CEUS = contrast-enhanced ultrasound; UCA = ultrasonographic contrast agent; US = ultrasound; contrast-enhanced ultrasound; hemangioblastoma; iCEUS = intraoperative CEUS; intramedullary tumor; intraoperative ultrasound; ioUS = intraoperative ultrasound; spinal tumor