Tumour of the brainstem

Tumour of the brainstem

Ms Ip was a 66 year old lady in good health. She had an MRI brain scan for investigation of dizziness in 2012 and an enhancing lesion on the dorsal aspect of the medulla was observed. It was consistent with a haemangioblastoma, and thought to be incidental to the mild clinical symptoms. Observation was recommended (see figures 1 and 2).

She remained stable but a repeat MRI scan in mid-2015 had shown that the enhancing nodule had increased in size and was associated larger cyst than previously observed. Again the lesion was consistent with it being a haemangioblastoma. Given the radiological progression (see figure 3), treatment was recommended.

2015a 0001She proceeded to surgery, with the goal of complete resection. A suboccipital craniotomy with C1 laminectomy was performed. The mass was easily identifiable and typical of a haemangioblastoma, with multiple small feeding blood vessels. The yellow/orange tinge to the tumour was reflective of the highly vascular nature of the tumour (Intraop pre). A complete resection was performed (intraop post).

The cyst was drained and the tumour nodule 2015post 0001removed. She did well postoperatively with mild right arm dyspraxia evident. This was thought to be due to a small amount amount of ischaemia, probably involving the right dorsal column nuclei (see figure 4). Over a few weeks this resolved.

The histology was consistent with a haemangioblastoma. These are benign tumours that can occur in the brain or spinal cord, but are commonest as isolated lesions in the posterior fossa. They are vascular and often associated with a cyst. Multiple lesions occur in von Hippel-Lindau syndrome.

 

By Prof David Walker

 

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