Hemangioblastoma, case 4

Clinical history
This 33-year-old female complains of severe and persistent low back pain for six months. The pain recently worsened radiating to the left leg with dysesthesia of the left foot.

Neurological examination
Hypoesthesia was found along the inner side of the left foot and big toe. Neurological examination was otherwise entirely normal.

MRI findings
Image 1: Sagittal T1WI. Left: irregular enlargement of the cord at the Th8-Th11 level with a cystic component. Right: Following contrast administration, a tumor nodule enhances strongly while no contrast uptake is seen at the level of the cystic component.
Image 2: Sagittal T2WI. The small solid nodule is hypointense (arrow). The homogeneously hyperintense associated cyst is well delineated.
Image 3: Axial Gd T1WI: The eccentric, posterior location of the nodule is shown as well as attachment to the adjacent leptomeninges.

Surgery
Total removal of a well circumscribed solid nodule was achieved under continuous intraoperative monitoring of somatosensory evoked potentials.

Histology
Hemangioblastoma

Clinical follow-up
Immediately after surgery, the patient experienced increased dysesthesia affecting both lower limbs. Those symptoms progressively resolved.

Immediate Post-operative Control MRI: (24 hours after surgery)
Image 4: Sagittal T1WI and image 5: Sagittal T2WI: Postoperative changes with laminectomy is seen. The associated cyst is still visible but already smaller.
Image 6: Sagittal Gd T1WI and image 7: Axial Gd T1WI.

Total removal of the solid nodule is observed. No contrast uptake is present.

Search also:
- Hemangioblastoma

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