Hemangioblastomas of the Lower Spinal Region: Report of Four Cases with Preoperative Embolization and Review of the Literature
Alessandra Biondia,
Giuseppe K. Ricciardia,c,
Tierry Faillotb,
Laurent Capelleb,
Rémy Van Effenterreb and
Jacques Chirasa
a Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris VI University, Paris, France
b Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris VI University, Paris, France
c Department of Radiology, University of Messina, Messina, Italy
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FIG 1. Case 1. Hemangioblastoma of the conus medullaris in a 24-year-old woman.
Sagittal (A) and coronal (C) T1-weighted MR images after administration of gadolinium show marked and enhancement of the tumor located at level of T12–L1 vertebral bodies. The lesion is associated with an intramedullary cyst extending to the middle thoracic region. On sagittal (B) and coronal (D) T2-weighted MR images, the lesion is predominantly isointense, heterogeneous with flow void due to high-flow vessels. The intramedullary cyst is better visualized. Multiple serpiginous images are observed compatible with dilated vessels. Before embolization, angiography of left first lumbar artery, early (E) and late (F) phase, shows that the tumor is predominantly fed by the ASA and by the right posterior spinal artery from the right third lumbar artery (not shown). A very slight vascular supply was also observed from the left posterior spinal artery originating from the left T11 intercostal artery (not shown). Embolization was performed through the ASA (artery of Adamkiewicz) from the left first lumbar artery. After embolization, angiography of the left first lumbar artery early (G) and late (H) phase, shows reduction of the tumoral blush. I, Right third lumbar artery angiography shows a residual tumoral blush fed by the posterior spinal artery. J, After embolization of this pedicle, no tumoral blush is observed.
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FIG 2. Case 2. Hemangioblastoma of the cauda equina in a 47-year-old woman with VHL disease.
Selective spinal angiography of the left second lumbar artery (A–D) shows the ASA (artery of Adamkiewicz) feeding the tumor (A, early, and B, late phase in anteroposterior view; C, early, and D, late phase in lateral view). Selective angiography of the left T10 intercostal artery (E, anteroposterior; F, lateral) shows an additional supply to the anterior spinal axis from a thoracic radiculomedullary artery. The left T10 intercostal artery also gives rise to a left posterior spinal artery (Lazorthes artery) providing a slight supply to the superior pole of the tumor. Descending anterior and ascending posterior venous drainages are observed. Embolization was performed through the anterior spinal axis from the left second lumbar artery. After embolization, selective spinal angiography of the left second lumbar artery (G–J) shows reduction of the tumoral blush tumor (G, early, and H, late phase in anteroposterior view; I, early, and J, late phase in lateral view).
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FIG 3. Case 3. Hemangioblastoma of the filum terminalis in a 61-year-old man.
Sagittal (A) and coronal (B) T1 MR images after administration of gadolinium show marked enhancement of the tumor located at level of L3 vertebral body. C, On sagittal T2 MR image, the lesion is predominantly isointense, heterogeneous with flow void due to high flow vessels. D, Angiography of left first lumbar artery shows that the tumor is fed by the anterior spinal axis. E, Intermediate step of embolization performed through the ASA (artery of Adamkiewicz) shows partial reduction of the tumoral blush. F, Final control angiography of the left first lumbar artery shows angiographic tumoral devascularization.
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