Microsurgical resection of a T11 holocord hemangioblastoma

Background: Hemangioblastoma (HB) is the third most common intramedullary spinal cord tumor and is frequently associated with secondary syringomyelia. Some cases with extensive cavitation may obscure the small underlying tumor. Although sporadic spinal HBs are located mostly in the cervical region, we present a T11 lesion case associated with a holocord syringomyelia. Case Description: A 51-year-old male renal transplant recipient presented with a 2-year history of progressive left-sided myelopathy. The magnetic resonance imaging demonstrated a T11 intramedullary lesion associated with extensive syringomyelia extending from the medulla oblongata to the upper lumbar region. The patient underwent a T10-T11 laminectomy and midline myelotomy. Intraoperative sodium fluorescein demonstrated a highly vascular tumor and assisted in defining tumor margins. The histopathology confirmed the diagnosis of a HB with extramedullary hematopoiesis. Complete tumor removal restored normal cerebrospinal fluid dynamics and syrinx regression. At 1-year postoperative follow-up, the patient was able to ambulate independently, and 4/5 strength was noted in the left upper extremity. Conclusion: A 51-year-old patient presented with myelopathy attributed to a T11 HB and an extensive syringomyelia. Microsurgical resection of the lesion allowed the syrinx to regress.