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Hemangioblastoma, case 1

 

Clinical history
This 57-year-old man presented with a 5 year history of progressive weakness and hypoesthesia of the right arm and subsequently of the left arm as well.

On neurological examination, there was slight weakness of both arms, bilateral extensor plantar response, and diminished pain and light touch sensation bilaterally below C2. Degree of disability: McCormick II.

Pre-operative MRI (April 1990)
Images 1 - 2: Sagittal T1WI. These images shows a mass lesion with an enlarged medulla oblongata and cervico-thoracic spinal cord to the T2 level. The margins are ill-defined and the lesion is heterogeneously iso- to hypointense. Note the cystic component at C6-C7 and at the posterior medulla oblongata level.
Images 3 - 4: Sagittal Gd T1WI. There is an enhancing nodule at the C1 level. The cyst walls do not enhance.
Image 5: Coronal Gd T1WI. The coronal view shows the heterogeneous mass lesion.

Surgery
Video 1: hemangioblastoma
Total removal of the nodular enhancing lesion was accomplished.

Stage 1: Commencing surgery.
Stage 2: Difficult dissection of the intraspinal tumor.
Stage 3: Separation of the tumor from the spinal cord without debulking.
Stage 4: Coagulation of the feeding vessels.
Stage 5: Tumor removed.
Stage 6: Low magnification view of the operative field.

Histology
Hemangioblastoma.

Post-operative clinical course
Immediately after the operation, the patient's clinical condition remained unchanged, with a degree of disability McCormick II. After three months his clinical condition improved and his degree of disability was reduced to McCormick I.

First follow-up MRI (May 1990)
Image 6: Sagittal T1WI. The medulla oblongata and cervical spinal cord have returned to normal size and almost normal signal intensity. A hypointense area in the medulla oblongata and a cervical syringomyelia remain visible.
Images 7 - 8: Sagittal Gd T1WI. No enhancing nodules are seen.

Second follow-up MRI (May 1992)
Image 9: Sagittal T1WI. A small syringomyelic cavity is still visible at the C6 level. Note the atrophy at C1-C2.
Image 10: Sagittal Gd T1WI. No contrast enhancement is visible.

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Fig. 1

Hemangioblastoma, case 1, Fig. 1
Hemangioblastoma, case 1, Fig. 2
Hemangioblastoma, case 1, Fig. 3
Hemangioblastoma, case 1, Fig. 4
Hemangioblastoma, case 1, Fig. 5
Hemangioblastoma, case 1, Fig. 6
Hemangioblastoma, case 1, Fig. 7
Hemangioblastoma, case 1, Fig. 8
Hemangioblastoma, case 1, Fig. 9
Hemangioblastoma, case 1, Fig. 10