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Journal of Korean Neurosurgical Society 2006;40(2): 117-121.
Surgery of a Solid Hemangioblastoma at the Cervicomedullary Junction.
Tae Won Kim, Shin Jung, Tae Young Jung, Sam Suk Kang
Department of Neurosurgery, Chonnam National University Hwasun Hospital, Medical School, Hwasun, Korea. sjung@chonnam.ac.kr
ABSTRACT
The surgical removal of solid deepseated hemangioblastomas remains challenging, because treatment of these lesions is often complicated by severe bleeding associated with the rich vascularity of this tumor, and by severe neural tissue injury associated with the difficulty of en bloc resection, especially when the tumor is located at the cervicomedullary junction. Therefore, preoperative embolization of deepseated solid hemangioblastomas may play an important role in successful surgical removal by reducing major bleeding and neural tissue damage. A 24-year-old woman, 28-weeks pregnant, was admitted to our hospital for the evaluation of quadriparesis, and brain magnetic resonance imaging(MRI) revealed intra-axial mass lesion in the cervicomedullary junction. After delivery, her neurologic symptoms became aggravated, and we decided to operate. Preoperative angiography revealed a hypervascular tumor in the posterior fossa, and embolization of the main feeding artery using gelfoam and microcoil, resulted in marked reduction of tumor vascularity. She underwent a midline suboccipital craniotomy involving the removal of the arch of C-1. The tumor was totally removed through a midline myelotomy, and at her 6-month follow-up she walked independently. We report on the combined use of the preoperative embolization of feeding vessels and subsequent operative resection in a patient with a solid hemangioblastoma at the cervicomedullary junction immediately after delivery.
Key Words: Preoperative embolization; Solid hemangioblastoma; Cervicomedullary junction; Midline myelotomy; Pregnancy
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