A sunset tumor, or hemangioblastoma, is unlike any other because of its orange color. The color comes from its unusually robust blood supply.
Hemangioblastomas are very rare: only about one in ten spinal cord tumors turns out to be one. This kind of tumor is usually benign but because of its location in the spinal cord, surgical removal is almost always advised.
There is an art to their removal and Dr. Paul McCormick, director of The Spine Hospital at the Neurological Institute of New York, has produced a video, that he hopes will help other surgeons identify and safely remove this unusual type of tumor.
In this video, Dr. McCormick begins by describing his patient, a woman in her 40s who has been having signs of spinal cord compression. Her MR images have enabled him to diagnose her tumor. Then he uses close-up footage from his surgical microscope and narrates the operation in a voice-over.
When the operation begins, it is easy to notice that one otherwise clear membrane over the spinal cord has a cloudy pinkish area in it. This pinkish area obscures the blood vessels that squiggle along the surface of the spinal cord like rivers across a landscape. Just at the edge of that cloudy pinkish area, Dr. McCormick points out a “sunset orange” nodule. This, he explains, is the visible part of the hemangioblastoma.
In his voice-over, Dr. McCormick notes that, although only a nodule is visible, the tumor is actually large and roundish. He explains what common surgical techniques should not be used on this tumor, and why not. And he shares the key to this tumor’s safe removal–working in a circle that goes all the way around the visible part of the tumor before proceeding down a layer to repeat the process.
Dr. McCormick narrates his techniques as he progressively divides the tumor from the surrounding tissue. Finally, the “sunset orange” tumor is fully removed. The procedure has been a textbook success. And while a hemangioblastoma is often likened to a sunset in color, Dr. McCormick’s patient might compare its removal to a sunrise. She was up and around the second day after surgery, completely tumor-free.
This video is part of a special supplement of surgical videos published by Journal of Neurological Surgery: Neurosurgical Focus. Dr. Paul McCormick edited the section of the JNS supplement about “intradural” spinal surgery (any surgery that opens a membrane called the dura). He produced some videos himself, and solicited other videos from other experts.
Journal of Neurosurgery has made all the videos available on Youtube. This video can be watched here: Microsurgical Resection of Intramedullary Spinal Cord Hemangioblastoma. But be aware: the video is a graphic and close-up look at surgery. It is intended as a learning tool for other surgeons. It should be viewed only by interested adults, and with caution.