Microsurgical Resection of a Spinal Cord Hemangioblastoma With Ventral Pial Attachment Through a Posterior Approach: 2-Dimensional Operative Video

Abstract

This video demonstrates microsurgical resection of a spinal cord hemangioblastoma with ventral pial attachment through a posterior approach. Although majority of intra-medullary spinal cord hemangioblastomas are with posterior pial attachment, rarely tumors are with ventral pial attachment.1-5 Safe surgical resection of spinal cord he-mangioblastomas with ventral pial attachment is challenging because of anteriorly lo-cated nature of tumors and difficulty of accessing ventral pial attachment.6 Moreover, as tumor feeders originate from the anterior spinal artery and its perforators, removing tumors without damaging them makes surgery more challenging.7 There are 2 surgical options: an anterior or posterior approach.8,9 This video is to illustrate the posterior approach surgery. The patient diagnosed with von Hipple-Lindau disease presented with a spinal cord hemangioblastoma with ventral pial attachment at the C3-C5 level and underwent a posterior approach surgery. The spinal cord was slightly rotated, and the dorsal median sulcus was leaned oblique because of the large tumor and associated syringomyelia. Dorsal midline myelotomy was achieved correctly with the dorsal column mapping. During the surgery, tumor dissection and division of feeders were done away from the anterior spinal artery and its perforators, which is the primary advantage of the posterior approach compared with the anterior approach. The tumor resection was achieved in an en bloc manner, and the patient remained at a neurological baseline after the surgery. The principles and detailed microsurgical techniques of tumor resection are illustrated in the video. The patient featured in this video consented to the procedure.