Microsurgical Treatment And Prognosis Of Hemangioblastoma Of Medulla Oblongata And High Cervical Spinal Cord

Objective:To analyze the clinical features,surgical methods and prognosis of patients with hemangioblastoma of medulla oblongata and high cervical spinal cord(Hemangioblastoma,HB),so as to improve the understanding of the disease and the effect of microsurgical treatment.Methods:Retrospective analysis the clinical data of 16 patients with hemangioblastoma located in the medulla oblongata and C1-4 segment in the Department of Neurology,the First Affiliated Hospital of Kunming Medical University from January 2015 to January 2019,the clinical manifestations,diagnosis and treatment process and prognosis of patients were analyzed.Results:All the 16 patients were confirmed to be hemangioblastoma by postoperative pathological examination,and there was no death during the perioperative period,including 14 cases of total resection and two patients located in the segments of medulla oblongata-Cl and C3-4.The blood supply of the tumor was extremely abundant,the adhesion was severe,and the tumor was widely bleeding in the process of separation.in order to reduce injury,subtotal resection was performed,and the total resection rate was 87.5%.Sixteen patients were followed up with an average of 26.5 months.Postoperative reexamination of MRI and cervical DR showed that there was no cervical deformity,15 patients had no tumor recurrence,1 patient with subtotal resection recurred at 18 months after operation,and no new tumor was found in 2 patients with VHL disease during the follow-up period.The postoperative symptoms of the patients were improved in varying degrees,with the highest improvement rate of head and neck pain relief(93.7%),sensory function improvement rate(78.6%),motor function improvement rate(66.7%)and ataxia improvement rate(60%).The postoperative McCormick spinal cord function grade and cervical JOA score were significantly improved compared with those before operation.Microsurgery had a significant effect on the treatment.The postoperative improvement rate was cured in 5 cases,effective in 6 cases,effective in 4 cases and ineffective in 1 case.Preoperative JOA score,age,course of disease and complete resection of tumor during operation were significantly related to prognosis,while gender,tumor diameter,location,growth and syringomyelia were not significantly related to prognosis.Conclusions:1.Microsurgery is the first choice for the treatment of hemangioblastoma in medulla oblongata and high cervical spinal cord2.Preoperative neurological status,age,course of disease and complete resection of tumor during operation are the main factors affecting prognosis.3.Microsurgical techniques and strategies are also factors affecting prognosis,requiring careful micromanipulation and vascular management during the operation.