Surgical management of intramedullary hemangioblastoma of the spinal cord

This is a study on 19 patients, who underwent complete excision of an intra medullary hemangioblastoma of the spinal cord during the period 1984-1997. The study was conducted to evaluate their functional outcome. Some peculiar ities of their clinical presentation and surgical treatment are discussed a s well. There were 12 males and 7 females whose age ranged from 16 to 69 ye ars. Five of 6 patients were affected by Lindau's disease had multiple intr amedullary tumors. The length of their history averaged 22.6 months. While pain was the most common complaint at presentation, 12 out of 19 patients h ad progressive sensorimotor deficits. A total of 22 operation was performed . One patient underwent resection of a minute tumor residue a few months af ter the first operation. In 2 patients with multiple tumors a second tumor, which became clinically relevant, was resected 17 and 36 months after the first operation. There was no mortality. One patients developed a wound inf ection which required secondary closure. The functional status of the patie nts registered at discharge was worse in 22.7%, unchanged in 59.1%, and imp roved in 18.2% of the patients. At follow-up (6-142 months), the status of 9.1% of the patients was still worse, in 50% was unchanged and in 40.9% bet ter than the preoperative one. All but one patients had complete postoperat ive pain relief. The data support the concept that radical excision of intr amedullary hemangioblastomas can be achieved at low levels of surgical mort ality and morbidity. Symptomatic patients should undergo surgery before the y develop extensive sensorimotor deficits. In patients with multiple lesion s, tumors distant from the symptomatic one should not be tackled.