Multiple spinal hemangioblastomas complicated with postoperative remote cerebellar hemorrhage: review of the literature of two rare entities.

Abstract

Multiple spinal hemangioblastomas constitute a rare pathology; most patients have von Hippel-Lindau disease. In the literature, spinal surgery has been complicated with remote intracranial hemorrhage in a very few cases. A 51-year-old woman, with no pertinent familial past medical history, presented with low back pain. Medullary magnetic resonance imaging revealed 3 spinal extramedullary tumors. The tumor at the L4 level appeared as a dumbbell-shaped neurinoma-like mass with enlarged vessels nearby. Medullary angiography excluded a dural fistula. Surgery was performed in 2 stages for all lesions. The day after lumbar surgery, the patient became comatose because of a remote cerebellar hemorrhage associated with hydrocephalus. She underwent external ventricular drainage and posterior fossa craniectomy. The patient recovered fully at 35 days except for a slight disorientation and diplopia. Histology of all lesions revealed hemangioblastomas. Discussion of this case concerns radiologic features of spinal hemangioblastomas, diagnosis of von Hippel-Lindau disease, and pathophysiology of hemorrhagic complications following spinal surgery. This case report includes 2 rare entities, of which every spinal surgeon should be aware.