Spinal hemangioblastoma

A solitary 8.5 x 10 x 14mm (AP x LR x CC) marginally hyperattenuative well circumscribed lesion in the dorsal aspect of the spinal canal at the level of C2. Within the limits of this examination, the lesion appears to be intramedullary, causing slight anterior displacement of the spinal cord at this level. No hydrocephalus. Well circumscribed CSF density region superior to the lesion, within the spinal canal may reflect a prominent syrinx.

There is a 13 mm lesion demonstrated at the dorsal aspect of the cervical spinal cord at the T2 vertebral body level contains multiple internal flow voids with feeding vessels arising from the left VA demonstrated internally (best seen on ToF). The lesion is perimedullary with possible intramedullary extension and there is peripheral enhancement of a multiloculated large tumoral cyst extending through the central canal caudally from the lesion to the C5/C6 intervertebral disc level.
Cranial syringomyelic distension involving the obex and extending into the dorsal aspect of the medulla is likely to be secondary to distal obstruction.
There is also abnormal intramedullary spinal cord signal extending caudally from the inferior aspect of the tumoral cyst to approximately T1.

DSA confirms the presence of a 14 mm vascular tumor receiving arterial supply from a single hypertrophied muscular branch of the left V3/V4 junction arising at the level of the dural entry. This follows a tortuous course and is directed caudally. There is no definite arteriovenous shunt. A single draining vein, directed cranially, is also tortuous traveling around the left dorsal CSF space to drain into the left IPS. The left PICA is remote to the lesion throughout its length.