Cervical Hemangioblastoma Presenting in the Late Stage of Pregnancy: A Case Report

Background: Hemangioblastomas are rare, benign vascular tumors, primarily found in the cerebellum, brainstem, or spinal cord; account for about 4% of spinal cord tumors and are extremely rare in pregnant women, with only a few documented cases. Evidence suggests that pregnancy-related hemodynamic and hormonal changes can accelerate tumor growth and exacerbate symptoms. Increased Blood Volume may contribute to tumor enlargement and edema. Estrogen and progesterone might influence tumor growth directly or through vascular changes. Placental growth factor (PlGF) and vascular endothelial growth factor receptor-1 (VEGFR-1) might play roles in tumor progression during pregnancy. Rapid growth of hemangioblastomas can lead to severe neurologic symptoms, requiring urgent intervention. Case Presentaiton: Patient Details: 31-year-old Gravida 1 Para 0 female, 32+6 weeks estimated gestational age (EGA). Initial Presentation: Neck pain, headaches, left- sided decreased sensation. Strength, pulses, DTRs, and blood pressure were normal. Advised to go to ED for further evaluation. Progression: At 35+2 weeks EGA, presented with severe head and neck pain and left-sided radiculopathy; MRI revealed a spinal cord mass. Immediate Management: Scheduled cesarean section followed by spinal cord mass resection after a one-week recovery. Diagnosis: Pathology identified an intradural intramedullary cervical tumor, hemangioblastoma. Postoperative Course: Status post laminectomy and tumor resection, patient had left-sided body weakness and used a walker. Postpartum depression noted, but no suicidal ideation or thoughts of self-harm. Rehabilitation: Engaged in occupational therapy and outpatient physical therapy with some improvement in motor skills. Follow-up Care: Ongoing postpartum follow-up, neurologist consultation for von-Hippel Lindau disease and symptom management. Conclusion: This case underscores the importance of multidisciplinary collaboration in managing complex cases involving simultaneous obstetric and neurosurgical concerns. The successful outcome of the cesarean section followed by tumor resection illustrates the effectiveness of a well-coordinated care approach. Continuous monitoring, rehabilitation, and support are essential for optimizing recovery and addressing both the physical and psychological impacts of such a challenging situation. This case serves as a reminder of the need for vigilance in pregnant patients presenting with atypical symptoms and the benefits of a comprehensive, team-based management strategy.