Spinal Hemangioblastoma: The Role of Imaging Characteristics in Preoperative Diagnosis and Surgical Planning

Spinal hemangioblastomas are rare, highly vascular tumors of the central nervous system (CNS) that may occur sporadically or in association with von Hippel-Lindau disease. These tumors pose significant diagnostic and surgical challenges due to their intramedullary location and propensity for hemorrhage. Given their radiographic overlap with other spinal cord tumors, imaging plays a crucial role in preoperative diagnosis and surgical planning. We present the case of a 58-year-old woman who developed progressive left lower limb weakness and sensory impairment over two years. Magnetic resonance imaging (MRI) revealed a lobulated, heterogeneously enhancing solid-cystic lesion within the spinal canal at the T11-12 level, with a diffuse syrinx spanning the entire cord. Surgical resection was performed, with a highly vascular lesion encountered intraoperatively. Histopathology confirmed the diagnosis of hemangioblastoma, classified as World Health Organization (WHO) grade 1. Reviewing the literature, certain radiographic features can aid in the diagnosis of spinal hemangioblastomas, improving preoperative planning for patients with these tumors. Surgical implications include the contraindication to biopsy due to the tumor's vascularity, as well as preparation of blood products and preoperative patient counseling.