# Comparing laminectomy and unilateral hemilaminectomy in spinal hemangioblastoma resection: A multicenter study

## TL;DR

This study finds that two surgical approaches for spinal hemangioblastomas lead to similar outcomes, with tumor characteristics more important than the surgical method.

## Contribution

The study provides a multicenter comparison of laminectomy and hemilaminectomy for spinal hemangioblastoma resection, identifying key predictors of outcomes.

## Key findings

- Laminectomy and hemilaminectomy result in similar complete resection rates for spinal hemangioblastomas.
- Multisegmental tumor involvement is the main predictor of postoperative bleeding.
- Incomplete resection is associated with tumor location and preoperative neurological impairment, not surgical technique.

## Abstract

This study compared laminectomy and hemilaminectomy for resection of spinal (sHBs), evaluating extent of resection, 12-month postoperative functional outcomes, perioperative complications overall, with particular attention to postoperative bleeding.

This retrospective international multicenter study included 280 primary sHB patients from 13 neuro-oncological centers who underwent either laminectomy (n = 125) or hemilaminectomy (n = 155). The endpoints were the extent of resection, functional outcomes at 12 months, and postoperative bleeding requiring retreatment. Multivariable logistic regression analysis was performed to determine independent risk factors associated with these outcomes.

The rate of complete resection was similar between both surgical approaches, with 86.4% in the laminectomy group and 90.3% in the hemilaminectomy group (p = 0.35). Independent predictors of incomplete resection included preoperative modified McCormick >2 (OR: 4.29, p = 0.001), combined intra- and extramedullary tumor location (OR: 2.91, p = 0.03), and cervical or thoracic tumor location (OR: 3.38, p = 0.01). Functional outcomes at 12 months did not differ significantly between the laminectomy- and hemilaminectomy-groups (p = 0.97). Postoperative bleeding was more frequently observed in tumors involving two or more spinal segments (OR: 14.6, p = 0.01). The choice of surgical approach did not impact the incidence of postoperative bleeding (p = 0.55).

Laminectomy and hemilaminectomy result in comparable outcomes of sHB. Tumors affecting multiple spinal segments are associated with an increased risk of postoperative bleeding, while combined intra- and extramedullary growth, impaired preoperative functioning and non-lumbar location were associated with incomplete resection. Given the comparable outcomes, the selection of the surgical approach may be guided by surgeon preference and individual patient anatomy.

Image 1

•Laminectomy and hemilaminectomy achieve comparable rates of complete resection in spinal hemangioblastomas.•Multisegmental tumor involvement is the main predictor of postoperative bleeding, independent of approach.•Incomplete resection is primarily associated with tumor location and preoperative neurological impairment rather than surgical technique.

Laminectomy and hemilaminectomy achieve comparable rates of complete resection in spinal hemangioblastomas.

Multisegmental tumor involvement is the main predictor of postoperative bleeding, independent of approach.

Incomplete resection is primarily associated with tumor location and preoperative neurological impairment rather than surgical technique.