Intradural extramedullary hemangioblastoma.

Dr. Everton Barbosa da Silva – Rua Padre Marinho 480 / 504 30140-040 Belo Horizonte MG Brasil. E mail: [email protected] Hemangioblastoma of the spinal cord was first described by Schultze in 1912, with the first successful resection of this type of tumor performed on the same occasion. In 1928, Cushing and Bailey proposed the term hemangioblastoma in order to distinguish it from arteriovenous malformations. Hemangioblastomas are highly vascularized rare benign tumors, classified as grade I by the WHO, which are poorly described in the literature. The histogenesis of these tumors is uncertain and they are often cystic and might be associated with peritumoral edema and/or syringomyelia. Cure is possible by complete surgical excision. The advent of magnetic resonance imaging (MRI) has increased the number of cases of hemangioblastoma described in the literature. The extramedullary location of spinal cord hemangioblastomas is extremely rare. A case of an intradural extramedullary hemangioblastoma in a 66 year-old woman without von Hippel-Lindau disease (VHL) is reported here. CASE A 66 year-old woman presented with a six month history of progressive weakness and paresthesia in the lower limbs accompanied by important walking difficulty and lumbar pain irradiating to the right side of the abdomen. Physical examination showed the presence of paraparesis accompanied by objective signs of pyramidal syndrome, in addition to thermal and painful hypoesthesia, with the sensory level located at T10. MRI demonstrated an expansive intradural extramedullary lesion at T10–T11, exerting important compression and left anterolateral deviation of the thoracic spine, with slightly lobular contours, which was homogenously contrast enhancing (Fig 1). An enlarged vascular structure was observed below the lesion (Fig 2). The patient was submitted to laminectomy from T9 to T12. After opening the dura mater, a cystic reddish tumor was visualized just dorsolateral to the spinal cord. Several tortuous blood vessels were observed around the mass. The tumor was removed en bloc by microdissection on a well-defined cleavage plane.