A novel neuroimaging assessment of predictive risk factors associated with intraoperative massive hemorrhage in intracranial solid hemangioblastoma

• Published in: Quantitative imaging in medicine and surgery Vol. 9; no. 11; pp. 1781 - 1791
• Main Authors: Gao, Qiang, Zhang, Lan, Wang, Guoqing, Xu, Dingkang, Feng, Mengzhao, Wang, Fang, Wei, Qingjie, Liu, Xianzhi, Guo, Fuyou
• Format: Journal Article
• Language: English
• Published: China AME Publishing Company 01.11.2019
• Subjects: Original; surgical risk prediction; intraoperative blood loss (IBL); neurosurgery; Solid hemangioblastomas (SHs); neuroimaging assessment
• ISSN: 2223-4292; 2223-4306
• DOI: 10.21037/qims.2019.09.05

A solid hemangioblastoma (SH) is a benign and highly vascularized tumor. Microsurgical treatment of SH is still challenging due to excessive intraoperative bleeding. Sixty-six consecutive patients with SH were retrospectively analyzed. The volume of intraoperative blood loss (IBL) and the features detected by magnetic resonance imaging (MRI) were evaluated by a neurosurgeon and multiple neuroradiologists. Four striking MRI features-peritumoral edema, the flow-void effect, large draining veins, and a visible feeding artery-were related to excessive IBL. Regarding the weighted values of these risk factors, the flow-void effect was the factor most significantly correlated with IBL (P<0.01, R=0.418). The feeding artery also contributed substantially to excessive IBL (P<0.05, R=0.412). The next most influential factor was the presence of large draining veins (P<0.05, R=0.350), followed by peritumoral edema (P<0.05, R=0.308). The four major risk factors-the flow-void effect, feeding arteries, large draining veins, and peritumoral edema-were assigned point values of 3, 3, 2, and 1, respectively, for a maximum total score of 9 points. A higher total score indicates that a higher volume of bleeding is more likely to occur during surgery. This study reports the potential neuroimaging-based risk factors leading to abundant IBL in SH by neuroimaging assessment. The study proposes a novel scoring system to predict IBL, potentially decreasing the risk involved in the surgical treatment of SH.