Resection of a highly vascular lumbosacral spinal hemangioblastoma

Abstract

Spinal hemangioblastomas (sHGB) represent unique operative challenges given their exquisite vascularity and rare incidence. Herein, we present a case of a 50-year-old gentleman with progressive cauda equina syndrome secondary to a lumbosacral sHGB. The lesion exhibited vascular shunting and dilation of veins tracking the entire spinal cord. We performed an L2-5 laminoplasty, utilized intra-operative electrostimulation and high frequency ultrasonography to achieve a gross total resection and a good neurological outcome. We present an operative video demonstrating an AVM-like surgical resection approach including sequentially identifying and cauterizing feeding radicular arteries and preserving a large draining vein until the lesion is completely disconnected. This operative approach is useful to visualize given the relative rarity of spinal hemangioblastomas.

Keywords

• Spinal hemangioblastoma
• Intradural tumor
• Flow voids
• Vascular shunting
• Cauda equina syndrome
• Intra-operative stimulation