Hemangioblastoma of the Filum Terminale Resected with the Aid of Intraoperative Indocyanine Green Angiography in a Patient Affected by Von Hippel Lindau Disease

Hemangioblastomas are benign tumours affecting the central nervous system (CNS) as sporadic case or as manifestation of von Hippel Lindau disease (VHL), a neoplastic multistemic autosomal dominant syndrome predisposing to develop CNS and visceral lesions. Hemangioblastomas are predominantly originating in the cerebellum and in the cervical and thoracic spinal cord; localization at the cauda equina and especially at the filum terminale are very rare. Spinal hemangioblastomas are more prevalent in VHLaffected patients rather than in sporadic cases; however, among the reported cases of hemangioblastomas of the filum terminale none were related to VHL syndrome. We report the case of 22 years-old woman affected by VHL disease who underwent surgical treatment of a hemangioblastoma of the filum terminale. Since hemangioblastomas are highly vascular tumours, their removal involves microvascular dissection techniques, in order to avoid early closure of tumoral venous drainage and to preserve functional arterial branches. For these reasons we utilized intraoperative indocyanine green angiography which provided fine dynamic images of tumour blood flow, thus enabling the surgeon to better understand the angioarchitecture of the lesion obtaining a precise distinction between feeding and draining vessels.