Abstract

Objective Stereotactic spinal radiosurgery may offer a complementary adjunct to microsurgery for patients with limited surgical candidacy due to significant medical comorbidities, aggressive or recurring tumors, or surgically inaccessible lesions. Our objective was to illustrate Intensity-Modulated Radiation Therapy (IMRT) treatment schemes in conjunction with surgical therapy for aggressive spinal neoplasms. Methods Case Report A 79-year-old man with severe progressive tetraparesis had an intradural-extramedullary mass at the C4-C5 level with severe spinal cord compression that extended out the foramen and anterior to the vertebral artery. Subtotal microsurgical resection was performed, completely decompressing the spinal cord and sparing the structures exiting the left neural foramen. Imaging at five-months follow-up showed tumor progression. Stereotactic radiosurgery was performed which arrested tumor growth. Results Multimodality treatment resulted in significant neurological recovery without repeat invasive techniques. Conclusion This case demonstrates that microsurgery followed by stereotactic spinal radiosurgery is an effective approach for the treatment of intradural-extramedullary hemangioblastoma. Multiple treatment modalities provide for individualized patient care.

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