CASE 16163 Published on 14.10.2018

Spinal Cord Hemangioblastoma



Case Type

Clinical Cases


A. A. Montes Tome, M. D. M. Velasco Casares, M. Diez Blanco, M. Oñate Miranda, S. Rizzo, M, G. C. Fernández-Pérez

Hospital Universitario Río Hortega, calle Dulzaina, 2, 47012 Valladolid, Spain;

21 years, female

Area of Interest Neuroradiology spine, Musculoskeletal spine ; Imaging Technique MR
Clinical History
A 21-year-old woman, with limb hypoesthesia upper left and episodes of hyperesthesia in
lower extremities.
Imaging Findings
Radiological Findings:

We visualized a tumoration in the cervical cord, central intramedullary, expansive, oval, with well-defined limits, extending from C5-C7, with slightly heterogeneous intermediate signal in T1 and T2, observing some images of tortuous appearance, in relation to vascular structures prominent
The tumor shows an intense and homogeneous enhancement, after administration of intravenous contrast, with a cystic component, which extends from C2 to D3, with a signal similar to that of the CSF and to the medullary edema.
Hemangiomablastoma of the spinal cord: it is a low-grade neoplasm, highly vascularized, of intramedullary location, it is the third in frequency at the spinal level. It can occur sporadically (68%) or in the context of von Hippel-Lindau syndrome (VHL) (32%). However, the sporadic form is more frequent, without gender predilection (M = F). With an average presentation of 30 years. They are benign vascular tumors, with no tendency to malignify.[1, 2, 3]

Clinical Perspective: The clinic is not different from other intramedullary tumors, and usually presents with: pain, weakness and sensitive / motor clinic.[1, 2, 3]

Perspective Image: The most common location is the cerebellum and only 3 to 13% of all hemangioblastomas occur in the spine, where they represent 1.6 to 5.8% of all spinal cord tumors. In the spine they are usually intramedullary. Extramedullary hemangioblastomas are infrequent. These can be intradural, extradural or extra-intradural. As for the spinal hemangioblastomas, the majority are located in the thoracic region, followed by the cervical region, being much less frequent in the lumbar and sacral region.[1, 2, 3, 4]
CT findings: A solid, intramedullary, expansive, elongated tumor with marked enhancement after administration of intravenous contrast, with prominent afferent vessels and associated cystic areas is observed. (80-100%).
Findings in Magnetic Resonance: In T1-weighted images are isointense or slightly hyperintense (25%), in T2-weighted sequences they present a hyperintense homogeneous signal with peritumoral edema, cystic and signal-empty areas, especially in large lesions. After contrast administration, the lesion usually presents marked enhancement, being homogeneous or heterogeneous depending on its size, without evidence of enhancement of the cystic component, and may present the lesion with solid ring enhancement. It is necessary to emphasize the need to study everything in the neuraxis to rule out the existence of other lesions.[4, 5, 6]
Angiographic Findings: a vascular nidus with prominent afferent and efferent vessels is characteristic.

Treatment: the complete micro-surgical resection of the tumor is the treatment of choice or combined with preoperative arterial embolization. Stereotactic radiosurgery ablation and bevacizumab, which has caused tumor regression in some cases, are also used. [5, 6, 7]

"Written informed patient consent for publication has been obtained"
Differential Diagnosis List
Spinal Cord Hemangioblastoma
Arteriovenous malformation (AVM)
Cavernous malformation
Vascular metastasis
Final Diagnosis
Spinal Cord Hemangioblastoma
Case information
DOI: 10.1594/EURORAD/CASE.16163
ISSN: 1563-4086