Hemangioblastoma, case 5

Clinical history
This 45-year-old patient complained of severe cervical pain. He had undergone C5-C6 discectomy six months earlier, at another institution, for disk herniation on the basis of a CT examination. Due to worsening pain, the patient sought neurosurgical consultation.

Image 1: Sagittal T1WI. Extensive and diffuse spinal cord expansion is present from C1 to T3. The spinal cord has a heterogeneous low signal intensity. Note the post-operative changes at the C5-C6 level: anterior vertebral fusion with a hypointense artificial graft (Cloward procedure).
Image 2: Sagittal PD images confirm cord expansion. The cord is diffusely hyperintense on this imaging sequence.
Image 3: Sagittal PD (left) and T2WI for comparison.
Image 4: Sagittal T2WI shows cord swelling and extensive abnormal high signal intensity of the entire spinal cord. The C5-C6 graft is hypointense on this imaging sequence as well. Note the presence of a questionable low signal intensity area located posteriorly within the spinal canal at the level of C5-C6.
Image 5: Sagittal Gd T1WI nicely demonstrates a small enhancing nodule posteriorly at C5.
Image 6: Axial T1WI at the level of C5-C6. The expanded cord fills the entire canal. No focal lesion is clearly visible.
Image 7: Axial Gd T1WI provides additional information about the posterior, peripheral location of the enhancing nodule.

Surgery
A small hemangioblastoma was totally removed.

Histology
Hemangioblastoma.

Post-operative clinical course
The patient's neurological status worsened immediately after surgery, with hypoesthesia of the left leg and difficulty walking. One year later, the patient no longer had gait disturbance but still complained of sensory disorders of the left leg.

Follow-up MRI (6 months after tumor removal)
Image 8: Sagittal T1WI, non-enhanced and enhanced images. The cord now has a more normal appearance with no evidence of tumor. Subtle deformation of the posterior part of the cord at the site of tumor resection can be appreciated.
Image 9: Sagittal PD and image 10: Sagittal T2WI. The abnormal high signal intensity areas previously seen in the expanded cord corresponding to extensive reactive edema have resolved.

Note
- 40% of hemangioblastomas are cervical.
- 80% of cord hemangioblastomas are solitary lesions.
The association of a small nodule and extensive cord enlargement is highly suggestive of hemangioblastoma and seems to correspond to the frequent behavior of those types of lesions. This appearance is secondary to the sub-pial location of these tumors interferring with the venous drainage of the spinal cord, and therefore generating edema.

Search also:
- Hemangioblastoma

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