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Spinal hemangioblastomas: analysis of surgical outcome and prognostic factors

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Abstract

The prognostic factors for surgically removed spinal hemangioblastomas, the impact of VHL disease on outcome, and the role of intraoperative neuromonitoring are still not completely clear. The aim of this study was to review our experience with spinal hemangioblastomas in order to assess potential predictors of neurological outcome after surgery. All cases of spinal hemangioblastomas removed at two Italian academic institutions from 1985 to 2020 were reviewed. Data about clinical presentation and symptom duration, diagnosis of VHL, surgical approach, use of IONM, duration of hospital stay, follow-up, and modified McCormick grade before and after surgery were extracted. Sixty-one patients (31 F, 30 M) underwent 69 surgeries to remove 74 spinal hemangioblastomas (37 cervical, 32 thoracic, 5 lumbar). Improvement was found in 32.3% of cases, neurological condition remained stable in 51.6% of cases, and deteriorated in 16.1% of patients. A worsening trend in VHL patients and an improvement trend in non-VHL patients were detected, despite the lack of statistical significance. Laminotomy and use of IONM were found to be associated with better outcome, although no association was found between surgery without IONM and worse outcome. In most cases, patients affected by spinal hemangioblastomas can expect a good long-term outcome. In our experience, laminotomy seems to be associated with better outcome compared to laminectomy. While its absence is not associated with worse outcome, IONM seems to be associated with a better neurological outcome. Our study suggests that the more impaired the preoperative neurological condition, the worse the outcome.

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Authors and Affiliations

  1. Department of Neurosciences, Biomedicine, and Movement Sciences, Institute of Neurosurgery, University of Verona, Polo Chirurgico “P. Confortini”, P.le Stefani 1, 37126, Verona, Italy

    Alberto Feletti, Alessandro Boaro, Davide Giampiccolo, Fabio Moscolo & Francesco Sala

  2. Unit of Neurosurgery, Department of Biomedicine, Metabolic Sciences and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy

    Giorgio Casoli & Giacomo Pavesi

  3. Familial Cancer Clinic and Oncoendocrinology, Veneto Institute of Oncology, IOV-IRCCS, Padova, Italy

    Massimiliano Ferrara

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Contributions

Alberto Feletti: conception and design of the work, analysis and interpretation of data, draft of the work, approval of the final version. Alessandro Boaro: analysis and interpretation of data, draft of the work, approval of the final version. Davide Giampiccolo: acquisition and interpretation of data, draft of the work, approval of the final version. Giorgio Casoli: acquisition of data, approval of the final version. Fabio Moscolo: acquisition of data, approval of the final version. Massimiliano Ferrara: acquisition of data, approval of the final version. Francesco Sala: design of the work, interpretation of data, critical revision, approval of the final version. Giacomo Pavesi: design of the work, interpretation of data, critical revision, approval of the final version.

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Feletti, A., Boaro, A., Giampiccolo, D. et al. Spinal hemangioblastomas: analysis of surgical outcome and prognostic factors. Neurosurg Rev 45, 1645–1661 (2022). https://doi.org/10.1007/s10143-021-01696-x

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  • DOI: https://doi.org/10.1007/s10143-021-01696-x

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