Objective and importance: Spinal hemangioblastomas usually occur as isolated, intramedullary, central nervous system masses, often as a component of von Hippel-Lindau syndrome. They may occasionally occur extradurally and give the appearance of vertebral hemangioma. Rarely, they may be purely osseous lesions. The surgical management of these lesions has not been elaborated. We present a case and discuss the management of multilevel osseous hemangioblastoma of the thoracic spine.
Clinical presentation: A 50-year-old woman with a history of thoracic hemangioblastoma 3 years earlier presented with progressive paraparesis. Imaging revealed circumferential tumor involvement of T7 to T9, inclusive. There was severe spinal cord compression.
Intervention: The patient underwent surgery via a bilateral lateral extracavitary approach to the tumor. This permitted a complete spondylectomy of T7, T8, and T9; complete tumor removal; and decompression of the spinal cord. Pathological analysis confirmed hemangioblastoma. The spine was reconstructed with an interbody expandable cage and pedicle screw fixation, all placed via the dorsal approach. The patient improved neurologically after the operation.
Conclusion: Although extremely rare, hemangioblastomas may occur in a purely osseous location. They may resemble vertebral hemangioma. Treatment should include aggressive surgical removal, although arduous, if appropriate. A bilateral lateral extracavitary approach is ideal for complete spondylectomy. With this technique, ventral and dorsal reconstruction of the spine through the same incision is possible.