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Yoo KH, Park DJ, Marianayagam NJ, Gu X, Pollom EL, Soltys SG, Chang SD, Meola A. Stereotactic Radiosurgery for Cranial and Spinal Hemangioblastomas: A Single-Institution Retrospective Series. Neurosurgery 2024; 94:630-642. [PMID: 37967154 DOI: 10.1227/neu.0000000000002728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/27/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Stereotactic radiosurgery (SRS) has been an attractive treatment modality for both cranial and spinal hemangioblastomas, especially for multiple lesions commonly associated with von Hippel-Lindau (VHL) disease. This study aims to provide the largest long-term analysis of treatment efficacy and adverse effects of SRS for cranial and spinal hemangioblastomas at a single institution. METHODS We evaluated the clinical and radiological outcomes of patients with hemangioblastomas treated with CyberKnife SRS at our institute from 1998 to 2022. The follow-up data were available for 135 hemangioblastomas in 35 patients. Twenty-eight patients had 123 hemangioblastomas associated with VHL, and 7 had 12 sporadic hemangioblastomas. The median age was 36 years, and the median tumor volume accounted for 0.4 cc. The SRS was administered with the median single-fraction equivalent dose of 18 Gy to the 77% median isodose line. RESULTS At a median follow-up of 57 months (range: 3-260), only 20 (16.2%) of the VHL-associated and 1 (8.3%) sporadic hemangioblastomas progressed. The 5-year local tumor control rate was 91.3% for all hemangioblastomas, 91.7% among the sporadic lesions, and 92.9% in patients with VHL. SRS improved tumor-associated symptoms of 98 (74.8%) of 131 symptomatic hemangioblastomas, including headache, neck pain, dizziness, visual disturbances, dysesthesia, ataxia, motor impairment, seizures, and dysphagia. Two patients developed radiation necrosis (5.7%), and 1 of them required surgical resection. CONCLUSION SRS is a safe and effective treatment option for patients with hemangioblastomas in critical locations, such as the brainstem, cervicomedullary junction, and spinal cord, and in patients with multiple hemangioblastomas associated with VHL disease.
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Affiliation(s)
- Kelly H Yoo
- Department of Neurosurgery, Stanford University School of Medicine, Stanford , California , USA
| | - David J Park
- Department of Neurosurgery, Stanford University School of Medicine, Stanford , California , USA
| | - Neelan J Marianayagam
- Department of Neurosurgery, Stanford University School of Medicine, Stanford , California , USA
| | - Xuejun Gu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford , California , USA
| | - Erqi L Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford , California , USA
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford , California , USA
| | - Steven D Chang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford , California , USA
| | - Antonio Meola
- Department of Neurosurgery, Stanford University School of Medicine, Stanford , California , USA
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Matloob SA, Paraskevopoulos D, O'Toole SM, Drake W, Plowman N, Foroglou N. VHL: Trends and Insight into a Multi-Modality, Interdisciplinary Approach for Management of Central Nervous System Hemangioblastoma. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:81-88. [PMID: 38153453 DOI: 10.1007/978-3-031-36084-8_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Von Hippel-Lindau (VHL) is a multi-system disease which results in significant morbidity from central nervous system (CNS) involvement as well as ocular, renal and neuro-endocrine effects. Haemangioblastomas of the CNS present a number of challenges. The natural history of these lesions is varied, as is the size and location within the CNS. Whilst surgery is considered the mainstay of treatment and best chance at curing these lesions, this is also often associated with significant risks due to the anatomical location of these lesions, most commonly the posterior fossa and spinal cord.We review the literature and describe our experience across two separate European VHL referral centres. Alternative treatment options and combined modalities are increasingly being used in the context of managing CNS haemangioblastomas. We analyse the increasing use of stereotactic radiosurgery and the evolution of medical treatments as potential future adjuncts to surgery. The availability of multiple modalities in our armamentarium is essential in tailoring a personalised treatment approach to these patients. Owing to the multi-systemic nature of the disease, in our experience, managing the care of patients with VHL is best delivered using an interdisciplinary approach utilising multiple specialties and adopting an individually tailored holistic approach.
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Affiliation(s)
- S A Matloob
- Department of Neurosurgery, Barts Health NHS Trust, London, UK.
- Department of Neurosurgery, Royal London Hospital, London, UK.
| | | | - S M O'Toole
- Department of Endocrinology, The Royal Hallamshire Hospital, Sheffield, UK
| | - W Drake
- Department of Endocrinology, Barts Health NHS Trust, London, UK
| | - N Plowman
- Department of Oncology, Barts Health NHS Trust, London, UK
| | - N Foroglou
- Department of Neurosurgery, AHEPA University Hospital, Thessaloniki, Greece
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3
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Tong Y, Sirhan D, Cortes M. Preoperative Diagnosis of Suprasellar Hemangioblastoma with Four-Dimensional Computed Tomography Angiography: Case Report and Literature Review. Indian J Radiol Imaging 2021; 31:499-509. [PMID: 34556940 PMCID: PMC8448223 DOI: 10.1055/s-0041-1734335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Purpose
Our case report presents the first case of suprasellar hemangioblastoma diagnosed preoperatively with dynamic computed tomography angiography (four-dimensional [4D] CTA) in a patient without Von Hippel-Lindau (VHL) disease. We illustrate the imaging characteristics of these exceedingly rare tumors and discuss the role of 4D CTA in confirming this diagnosis and guiding surgical management. Finally, we present a literature review of imaging findings, differential diagnosis, management, and prognosis.
Case
A 39-year-old woman known for diabetes mellitus type II and dyslipidemia presented with headache, bitemporal hemianopsia, and mild hyperprolactinemia. Initial diagnosis of suprasellar meningioma separate from pituitary gland was revised to definitive diagnosis of suprasellar hemangioblastoma after 4D CTA.
Conclusion
Suprasellar hemangioblastomas are extremely rare, often associated to VHL disease. They present as enhancing as suprasellar mass with prominent intra- and peritumoral vascular flow-voids on magnetic resonance imaging. 4D CTA confirms their vascular nature, demonstrates characteristic rapid shunting with feeding arteries, and enlarged draining veins, and is important in guiding surgical management.
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Affiliation(s)
- Yi Tong
- Department of Radiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Denis Sirhan
- Department of Neurosurgery, Montreal Neurological Hospital and Institute, Montreal, Quebec, Canada
| | - Maria Cortes
- Department of Radiology, McGill University Health Center, Montreal, Quebec, Canada.,Department of Radiology, Montreal Neurological Hospital and Institute, Montreal, Quebec, Canada
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Zibly Z, Cohen ZR, Peled A, Zach L, Nissim U, Attia M, Graves C, Camphausen K, Spiegelman R. Linear accelerator stereotactic radiosurgery can modulate the clinical course of Hemangioblastoma: Case series and review of the literature. J Clin Neurosci 2020; 82:162-165. [PMID: 33317726 DOI: 10.1016/j.jocn.2020.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 08/10/2020] [Accepted: 09/07/2020] [Indexed: 01/07/2023]
Abstract
Hemangioblastomas (HB) are benign low grade vascular tumors most frequently occurring in the cerebellum, brain stem, and spinal cord. Often associated with Von Hippel Lindau disease (VHL), the lesions are often multifocal requiring complex resection and are difficult to control. Linear Accelerator (LINAC) Stereotactic Radiosurgery (SRS) has been demonstrated to provide additional tumor control. In this case series, we present our multi-center experience utilizing LINAC SRS in fourteen patients with 23 lesions. We observed a tumor control rate of 87% and found interval changes in the peritumoral enhancement to correlate with treatment outcome. In our study, SRS treatment was also well-tolerated in both cystic and noncystic patients with multifocal disease. Disease control was achieved in all but three patients post-resection and no longitudinal radiation-induced secondary malignancy was observed. SRS response correlated highly with lesion size and radiation dose. We conclude that LINAC SRS is safe and effective for patients with HB and should be considered in addition to surgery in asymptomatic, VHL patients, deep seated lesions and isolated lesions.
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Affiliation(s)
- Z Zibly
- The LINAC Radiosurgery Unit, Department of Neurological Surgery, The Chaim Sheba Medical Center, Tel Hashomer and the Sakler School of Medicine, Tel Aviv University, Israel; Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, United States.
| | - Z R Cohen
- The LINAC Radiosurgery Unit, Department of Neurological Surgery, The Chaim Sheba Medical Center, Tel Hashomer and the Sakler School of Medicine, Tel Aviv University, Israel
| | - A Peled
- The LINAC Radiosurgery Unit, Department of Neurological Surgery, The Chaim Sheba Medical Center, Tel Hashomer and the Sakler School of Medicine, Tel Aviv University, Israel
| | - L Zach
- Radiation Oncology Branch, Department of Oncology, The Chaim Sheba Medical Center, Israel and the Sakler Faculty of Medicine, Tel Aviv University, Israel
| | - U Nissim
- The LINAC Radiosurgery Unit, Department of Neurological Surgery, The Chaim Sheba Medical Center, Tel Hashomer and the Sakler School of Medicine, Tel Aviv University, Israel
| | - Moshe Attia
- The LINAC Radiosurgery Unit, Department of Neurological Surgery, The Chaim Sheba Medical Center, Tel Hashomer and the Sakler School of Medicine, Tel Aviv University, Israel.
| | - Christian Graves
- Department of Neuroscience, University of South Carolina School of Medicine, Columbia, United States
| | - K Camphausen
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, United States
| | - R Spiegelman
- The LINAC Radiosurgery Unit, Department of Neurological Surgery, The Chaim Sheba Medical Center, Tel Hashomer and the Sakler School of Medicine, Tel Aviv University, Israel
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Bartoš R, Lodin J, Marek T, Sameš M, Němcová V, Liščák R. Combined treatment of a medulla oblongata hemangioblastoma via permanent cysto-cisternal drainage and (postponed) gamma knife radiosurgery: a case report and review of the literature. Int J Neurosci 2020; 132:1-5. [PMID: 32881600 DOI: 10.1080/00207454.2020.1819267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/22/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hemangioblastomas are histologically benign tumors with a variable degree of morbidity and mortality based on various factors, including their anatomical location. The following paper illustrates a unique approach of combined therapy of a brainstem hemangioblastoma (HB) not associated with von Hippel-Lindau disease (vHLd) located in the medulla oblongata. CASE DESCRIPTION A 21-year-old preschool teacher presented with vertigo, followed by dysphagia, trouble coughing, tongue paresis and headache and vomiting. Magnetic resonance imaging (MRI) revealed a large cystic lesion with a small intramural nodule located in the left anterolateral medulla oblongata directly behind the vertebral artery. The diagnosis of hemangioblastoma was supported by digital subtraction angiography. CONCLUSION Combined therapy consisted primarily of acute surgical fenestration and permanent drainage of the cystic portion of the tumor, due to symptomatic expansion. Follow-up stereotactic gamma knife radiosurgery was performed after 2 years for minor progression of the tumor nodule. To the best of our knowledge, this is the first time such approach has been described in the literature for this pathology.
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Affiliation(s)
- Robert Bartoš
- Department of Neurosurgery, Masaryk Hospital, Ústí nad Labem, Czech Republic
- Department of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Lodin
- Department of Neurosurgery, Masaryk Hospital, Ústí nad Labem, Czech Republic
| | - Tomas Marek
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Martin Sameš
- Department of Neurosurgery, Masaryk Hospital, Ústí nad Labem, Czech Republic
| | - Veronika Němcová
- Department of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Roman Liščák
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
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Kasapas K, Malli A, Sfikas S, Georgakoulias N. Sporadic Pituitary Stalk Hemangioblastoma: A Rare Case Report and Review of the Literature. Cureus 2020; 12:e9107. [PMID: 32789052 PMCID: PMC7417129 DOI: 10.7759/cureus.9107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Supratentorial hemangioblastomas have rarely been described in the literature. Pituitary stalk hemangioblastomas are extremely rare and almost always are associated with von Hippel Lindau disease. Herein, we report a sporadic case of pituitary stalk hemangioblastoma in a 36-year-old male and review the current literature regarding this pathology. In our case, complete resection of the lesion was achieved using the transglabellar approach.
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Affiliation(s)
| | - Antonia Malli
- Neurosurgery, The National and Kapodistrian University of Athens School of Health Sciences, Athens, GRC
| | - Spyros Sfikas
- Neurosurgery, 251 Air Force General Hospital, Athens, GRC
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7
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Qiu J, Cai D, Yang F, Zhou J, Gong Y, Cai L, Gong K. Stereotactic radiosurgery for central nervous system hemangioblastoma in von Hippel-Lindau disease: A systematic review and meta-analysis. Clin Neurol Neurosurg 2020; 195:105912. [PMID: 32474257 DOI: 10.1016/j.clineuro.2020.105912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/10/2020] [Indexed: 12/23/2022]
Abstract
Von Hippel-Lindau (VHL) disease is a dominantly inherited disorder marked by multiorgan tumors, such as central nervous system benign hemangioblastomas (CHB). Stereotactic radiosurgery (SRS) has also been used to treat CHB for a long time. The purpose of this meta-analysis is to provide a long-term outcome of SRS for VHL-associated CHB by reviewing published studies. We completed a Pubmed/Embase/SCOPUS/Cochrane Library literature search to get eligible studies published from January 1990 to December 2019 about using SRS to treat VHL-associated CHB. 15 studies met eligibility for qualitative systematic review, of which nine studies were ultimately eligible for quantity meta-analysis of 5-year tumor control rates (TCR), representing 170 subjects with a total of 660 lesions. Gamma Knife was the most published SRS method for VHL-associated CHB. The pooled 5-year TCR across the nine studies was 0.919 (95 %CI: 0.881-0.957). The pooled 5-year TCR for only intracranial lesions across eight studies was 0.917 (95 %CI: 0.876-0.957). Individual patient data were extracted from 9 studies, representing 298 lesions of 70 subjects. Sex, tumor volume, radiosurgery methods, marginal doses, maximum doses, the number of tumors for radiosurgery, age at the time of radiosurgery, tumor locations were not proven to be associated with tumor progression. SRS offered a satisfactory 5-year tumor control of CHB for VHL patients. Despite the paucity of randomized control trials, SRS is recommended to patients with limited surgical alternatives. However, the long-term outcomes and underlying factors associated with tumor progression remain to be investigated.
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Affiliation(s)
- Jianhui Qiu
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Desheng Cai
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Fan Yang
- Department of Urology, Peking University First Hospital, Beijing, China
| | - Jingcheng Zhou
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Yanqing Gong
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Lin Cai
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China
| | - Kan Gong
- Department of Urology, Peking University First Hospital, Beijing, China; Institute of Urology, Peking University, Beijing, China; National Urological Cancer Center, Beijing, China.
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8
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Kim EH, Moon JH, Kang SG, Lee KS, Chang JH. Diagnostic challenges of posterior fossa hemangioblastomas: Refining current radiological classification scheme. Sci Rep 2020; 10:6267. [PMID: 32286416 PMCID: PMC7156704 DOI: 10.1038/s41598-020-63207-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 03/26/2020] [Indexed: 11/29/2022] Open
Abstract
Hemangioblastomas (HBMs) are known to exhibit very typical radiological features and thus classified by well-established radiological classification scheme. We reviewed our series of posterior fossa HBMs in order not only to evaluate the relevance of current classification scheme, but also to possibly refine it. Also, we added descriptions on several cases with unusual radiological magnetic resonance imaging (MRI) findings in which differential diagnosis was challenging. We retrospectively reviewed preoperative MRI of 118 patients with pathologically diagnosed posterior fossa HBMs at our institution between 2002 and 2015. Total 128 tumors were included to this study and classified into four categories based on the presence and nature of cystic components: extratumoral cystic (Type Ce, classical cystic with a mural nodule), intratumoral cystic (Type Ci), mixed cystic (Type Cm), and solid (Type S). The association with von Hippel-Lindau (VHL) disease was also investigated. In 118 patients (65 male and 53 female), 79 (66.9%) had solitary HBMs and 39 (33.1%) were diagnosed with VHL disease. Type Ce with typical radiological findings was the most prevalent type of HBM (63.3%), followed by Type S (21.1%). HBMs with intratumoral cysts were uncommon (Type Ci, 11.7%) and mixed extratumoral and intratumoral cysts (Type Cm) accounted for only 3.9%. No intergroup differences were observed in the proportions of each subtype between the solitary and VHL disease-associated HBMs. The blood loss was much lower in Type Ce than in other subtypes. In Type Cm, radical resection was often challenging as the differentiation between intratumoral and extratumoral cysts was difficult resulting in incomplete resection. Refined radiological classification scheme is more practical because it does not only help surgeons determine whether the cystic wall should be removed or not, but also covers cases with atypical radiological presentations. For solid and extraparenchymal HBMs, differential diagnosis is more difficult as well as very critical as surgical removal is often very challenging.
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Affiliation(s)
- Eui Hyun Kim
- Department of Neurosurgery, Brain Tumor Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ju Hyung Moon
- Department of Neurosurgery, Brain Tumor Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seok-Gu Kang
- Department of Neurosurgery, Brain Tumor Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyu Sung Lee
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Brain Tumor Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Hattori Y, Tahara S, Yamada O, Yamaguchi M, Ishisaka E, Morita A. Suprasellar Hemangioblastoma with Reversible Edema-Like Change Along the Optic Tract: A Case Report and Literature Review. World Neurosurg 2018; 114:187-193. [PMID: 29581015 DOI: 10.1016/j.wneu.2018.03.114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/15/2018] [Accepted: 03/16/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hemangioblastomas usually occur in the cerebellum and are often a component of von Hippel-Lindau disease. Edema-like changes along the optic tract are commonly observed in association with tumors in the sellar and suprasellar regions, such as craniopharyngiomas and pituitary adenomas. Here, we describe a case of sporadic suprasellar hemangioblastoma with edema-like changes along the optic tract that completely resolved after surgery. CASE DESCRIPTION The patient was a 28-year-old woman with failing vision and a bitemporal hemianopia. Magnetic resonance imaging revealed a tumor accompanied by a 10-mm cyst. Fluid-attenuated inversion recovery axial magnetic resonance imaging revealed a hyperintense region along the optic tract. Other regions of the central nervous system were normal. Endoscopic transsphenoidal surgery was performed, and the histopathologic findings confirmed hemangioblastoma. Six months after surgery, the edema-like change along the optic tract had disappeared. The patient is doing well without pituitary insufficiency, pituitary hormone medications, or signs of tumor recurrence. In addition, the genetic test was negative for von Hippel-Lindau mutations. CONCLUSIONS When examining a patient with suprasellar tumor, clinicians must consider the possibility of hemangioblastoma. Adequate treatment can improve the edematous change and visual disturbance.
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Affiliation(s)
- Yujiro Hattori
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan; Department of Anatomy and Neurobiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
| | - Shigeyuki Tahara
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Osamu Yamada
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | | | - Eitaro Ishisaka
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
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Alshafai N, Maduri R, Shail M, Chirchiglia D, Meyronet D, Signorelli F. Surgical approach for suprasellar hemangioblastomas preserving the pituitary stalk: Review of the literature and report of a further case. Clin Neurol Neurosurg 2018; 168:147-152. [PMID: 29550691 DOI: 10.1016/j.clineuro.2018.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/03/2018] [Accepted: 03/08/2018] [Indexed: 11/30/2022]
Abstract
Hemangioblastomas (HBLs) are challenging vascular tumours with rare suprasellar location Surgery is recommended in patients with visual impairment, endocrine disorders or hydrocephalus. Surgical removal of pituitary stalk HBLs is challenging due to their location and high vascularity. Our narrative review was guided by the question: "what is the more suitable surgical approach to excise a suprasellar HBL?". Pertinent English literature was scrutinized from database inception to October 2016. Eighteen articles matched our selection criteria. Among the surgically treated patients, 4 were treated through a trans-sphenoidal (TS) approach, 13 through a transcranial approach (2 of them after TS failure). Five other cases were treated with radiotherapy (adjuvant in 3 cases) and 9 patients were managed with simple observation and/or medical treatment. We add a case of complete suprasellar HBL resection through an orbito-zygomatic (OZ) craniotomy with extradural anterior clinoidectomy (EAC). To achieve satisfactory oncologic results with acceptable morbidity for symptomatic suprasellar HBLs, complete tumour removal with pituitary stalk sparing should be attempted through an OZ craniotomy with EAC that provides adequate exposure of the tumour, its vascular supply and the adjacent neural structures.
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Affiliation(s)
- Nabeel Alshafai
- Alshafai Neurosurgical Academy (A.N.A.), Toronto, Ontario, Canada
| | - Rodolfo Maduri
- Department of Clinical Neurosciences, Service of Neurosurgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Mrigank Shail
- Xavier University School of Medicine, Aruba, The Netherlands
| | | | - David Meyronet
- Centre de Pathologie et de Neuropathologie Est, Hospices Civils de Lyon, Lyon, France
| | - Francesco Signorelli
- Department of Neurosurgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France; Division of Neurosurgery, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University "Aldo Moro" of Bari, Italy.
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11
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Stereotactic radiosurgery for central nervous system hemangioblastoma: systematic review and meta-analysis. J Neurooncol 2017; 137:11-22. [PMID: 29204841 DOI: 10.1007/s11060-017-2697-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 11/24/2017] [Indexed: 01/10/2023]
Abstract
Hemangioblastomas are rare, benign, vascular tumors of the central nervous system (CNS), often associated with von-hippel lindau (VHL) disease. Current therapeutic options include microsurgical resection or stereotactic radiosurgery (SRS). With no randomized controlled studies and minimal data beyond single-institution reviews, the optimal management approach for patients with CNS hemangioblastomas is unclear. We completed a Pubmed/SCOPUS literature search from January 1990 to January 2017 for eligible studies on SRS for CNS hemangioblastomas. Relevant articles were identified and reviewed in accordance to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. 26 studies met eligibility criteria for qualitative synthesis, representing 596 subjects and 1535 tumors. The Gamma Knife was the most published SRS method for CNS hemangioblastomas. After critical study appraisal for intra-study bias, 14 studies were used for quantitative meta-analysis of 5-year progression free survival (PFS). The pooled 5-year PFS across all eligible studies was 88.4%. No difference was observed between spine versus intracranial studies. Individual patient data (IPD) was extracted from 14 studies, representing 322 tumors. Univariate analysis of IPD revealed that VHL patients were younger, and had smaller tumors compared to those with sporadic disease. Adverse events were associated with increasing marginal dose, independent of tumor volume. VHL status, sex, radiosurgical method, tumor location, and tumor volume were not found to be significantly associated with tumor progression. Multiple studies show excellent tumor control at 5-year follow up, however, the long-term efficacy of SRS for CNS hemangioblastomas still needs to be investigated, and the studies exploring the role of SRS for early treatment of asymptomatic lesions is wanting.
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12
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Cheng J, Liu W, Hui X, Zhang S, Ju Y. Pediatric central nervous system hemangioblastomas: different from adult forms? A retrospective series of 25 cases. Acta Neurochir (Wien) 2017; 159:1603-1611. [PMID: 28752202 DOI: 10.1007/s00701-017-3275-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/12/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pediatric hemangioblastomas are rare, and the clinical features, timing of surgical intervention, optimal treatment, and clinical outcomes are still unclear. METHODS We performed a retrospective study of all patients with CNS hemangioblastomas who were treated at West China Hospital from January 2003 to March 2015. Patients under the age of 16 years were included in the study. The medical records of these patients were reviewed and statistically analyzed. RESULTS Twenty-five children (15 females and ten males, [mean age 12.6 ± 4.7 years, range 1-16 years]) presented with hemangioblastomas. Tumors were detected in the cerebellum, brainstem, and spinal cord in 40, 28, and 32% of patients, respectively. Sixteen children (64%) had VHL syndrome. The most frequent symptoms were those related to increased intracranial pressure. The mean duration of symptoms was 1.5 ± 2.1 months. Preoperative hydrocephalus was noted in 11 children (44%). Gross total resection was achieved in all children. Clinical symptoms improved in 19 children (76%), unchanged in four children (16%), and aggravated in two children (8%), respectively. The mean follow-up was 44.5 ± 32.3 months. Five patients (20%) experienced disease progression. Using univariate analysis, both tumor-associated cysts (P = 0.027) and VHL disease (P = 0.032) were significantly related to postoperative outcomes. CONCLUSIONS Pediatric hemangioblastomas have many different clinical features compared with adult cases. A high degree of suspicion for VHL disease should be raised in pediatric hemangioblastomas. Despite many challenges involved, surgical outcomes for pediatric hemangioblastomas are favorable. Lifelong follow-up is mandatory to detect the disease progression.
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Affiliation(s)
- Jian Cheng
- Department of Neurosurgery West China Hospital, Sichuan University, 37 Guo Xue Xiang, Wu Hou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Wenke Liu
- Department of Neurosurgery West China Hospital, Sichuan University, 37 Guo Xue Xiang, Wu Hou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xuhui Hui
- Department of Neurosurgery West China Hospital, Sichuan University, 37 Guo Xue Xiang, Wu Hou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Si Zhang
- Department of Neurosurgery West China Hospital, Sichuan University, 37 Guo Xue Xiang, Wu Hou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yan Ju
- Department of Neurosurgery West China Hospital, Sichuan University, 37 Guo Xue Xiang, Wu Hou District, Chengdu, 610041, Sichuan, People's Republic of China.
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Takayanagi S, Mukasa A, Nakatomi H, Kanno H, Kuratsu JI, Nishikawa R, Mishima K, Natsume A, Wakabayashi T, Houkin K, Terasaka S, Yao M, Shinohara N, Shuin T, Saito N. Development of Database and Genomic Medicine for von Hippel-Lindau Disease in Japan. Neurol Med Chir (Tokyo) 2017; 57:59-65. [PMID: 28070114 PMCID: PMC5341341 DOI: 10.2176/nmc.ra.2016-0206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
von Hippel-Lindau (VHL) disease is a hereditary tumor disease in which tumors develop in multiple organs, not only as hemangioblastomas (HBs) in the central nervous system, but also as kidney tumors, pheochromocytomas, and so on. Much about the epidemiology of VHL disease remained unknown until fairly recently in Japan, leading to calls for the establishment of a VHL disease epidemiological database in Japanese. To elucidate its epidemiology in Japan, the Japanese Ministry of Health, Labour and Welfare created the VHL Disease Study Group, which was put in charge of carrying out a nationwide epidemiological survey. The survey found close to 400 Japanese VHL disease patients throughout the country. Based on those results, the VHL Disease Study Group created the VHL Disease Treatment Guideline and also a severity classification. It is thought that the prognosis of VHL disease patients can be improved by performing genetic diagnosis and careful follow-up. Accordingly, the University of Tokyo Hospital put in place an in-hospital system for implementing genomic medicine for VHL disease based on genetic diagnosis. For that system, it was especially important to establish (I) accurate genetic diagnostic techniques, (II) genetic counseling capabilities for the patients and their families, and (III) a system of cooperation among multiple departments, including urology departments, and so on. Further elucidation of the epidemiology and the development of genomic medicine are needed to improve the treatment results of VHL disease in Japan.
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Pan J, Ho AL, D'Astous M, Sussman ES, Thompson PA, Tayag AT, Pangilinan L, Soltys SG, Gibbs IC, Chang SD. Image-guided stereotactic radiosurgery for treatment of spinal hemangioblastoma. Neurosurg Focus 2017; 42:E12. [DOI: 10.3171/2016.10.focus16361] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Stereotactic radiosurgery (SRS) has been an attractive treatment option for hemangioblastomas, especially for lesions that are surgically inaccessible and in patients with von Hippel-Lindau (VHL) disease and multiple lesions. Although there has been a multitude of studies examining the utility of SRS in intracranial hemangioblastomas, SRS has only recently been used for spinal hemangioblastomas due to technical limitations. The purpose of this study is to provide a long-term evaluation of the effectiveness of image-guided radiosurgery in halting tumor progression and providing symptomatic relief for spinal hemangioblastomas.
METHODS
Between 2001 and 2011, 46 spinal hemangioblastomas in 28 patients were treated using the CyberKnife image-guided radiosurgery system at the authors' institution. Fourteen of these patients also had VHL disease. The median age at treatment was 43.5 years (range 19–85 years). The mean prescription radiation dose to the tumor periphery was 21.6 Gy (range 15–35 Gy). The median tumor volume was 0.264 cm3 (range 0.025–70.9 cm3). Tumor response was evaluated on serial, contrast-enhanced CT and MR images. Clinical response was evaluated by clinical and imaging evaluation.
RESULTS
The mean follow-up for the cohort was 54.3 months. Radiographic follow-up was available for 19 patients with 34 tumors; 32 (94.1%) tumors were radiographically stable or displayed signs of regression. Actuarial control rates at 1, 3, and 5 years were 96.1%, 92.3%, and 92.3%, respectively. Clinical evaluation on follow-up was available for 13 patients with 16 tumors; 13 (81.2%) tumors in 10 patients had symptomatic improvement. No patient developed any complications related to radiosurgery.
CONCLUSIONS
Image-guided SRS is safe and effective for the primary treatment of spinal hemangioblastomas and is an attractive alternative to resection, especially for those with VHL disease.
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Affiliation(s)
| | | | | | | | | | | | | | - Scott G. Soltys
- 2Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Iris C. Gibbs
- 2Radiation Oncology, Stanford University School of Medicine, Stanford, California
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15
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Ji YC, Li Y, Hu JX, Zhang HB, Yan PX, Zuo HC. Cerebellar hemangioblastoma mimicking an aneurysm: A case report and literature review. Oncol Lett 2016; 12:2622-2624. [PMID: 27698835 PMCID: PMC5038381 DOI: 10.3892/ol.2016.4979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/15/2016] [Indexed: 11/26/2022] Open
Abstract
Hemangioblastomas (HBMs) are highly vascular tumors of the central nervous system. Sporadic HBMs are nearly always solitary, and solitary HBMs are similar to intracranial arteriovenous malformations due to their highly vascular characteristics. However, to the best of our knowledge, cases of HBM in the cerebellum mimicking an aneurysm have never been reported in the literature. The present study reports a case of an HBM on the right cerebellar hemisphere mimicking an aneurysm, which originated from the right posterior inferior cerebellar artery, as determined using magnetic resonance angiography and digital subtraction angiography. The patient was admitted the Department of Neurosurgery at the Tsinghua University Yuquan Hospital (Beijing, China) in January 2015 due to a 4-year history of intermittent headaches. The diagnosis of an HBM was determined during surgery and the tumor was totally resected by changing the operation technique, with no complications. In conclusion, it is difficult to distinguish between HBMs and intracranial vascular diseases, particularly aneurysms. Surgeons should consider the possibility carefully prior to surgery and careful prepare for each eventuality.
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Affiliation(s)
- Yu-Chen Ji
- Department of Neurosurgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, P.R. China
| | - Yan Li
- Department of Neurosurgery, Tsinghua University Yuquan Hospital, Beijing 100040, P.R. China
| | - Jing-Xia Hu
- Department of Neurosurgery, Tsinghua University Yuquan Hospital, Beijing 100040, P.R. China
| | - Hong-Bo Zhang
- Department of Neurosurgery, Xinhua Hospital of Hubei, Wuhan, Hubei 430015, P.R. China
| | - Peng-Xiang Yan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Huan-Cong Zuo
- Department of Neurosurgery, Tsinghua University Yuquan Hospital, Beijing 100040, P.R. China
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16
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Silva D, Grabowski MM, Juthani R, Sharma M, Angelov L, Vogelbaum MA, Chao S, Suh J, Mohammadi A, Barnett GH. Gamma Knife radiosurgery for intracranial hemangioblastoma. J Clin Neurosci 2016; 31:147-51. [PMID: 27422585 DOI: 10.1016/j.jocn.2016.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/08/2016] [Indexed: 11/25/2022]
Abstract
Gamma knife radiosurgery (GKRS) has become a treatment option for intracranial hemangioblastomas, especially in patients with poor clinical status and also high-risk surgical candidates. The objective of this study was to analyze clinical outcome and tumor control rates. Retrospective chart review revealed 12 patients with a total of 20 intracranial hemangioblastomas treated with GKRS from May 1998 until December 2014. Kaplan-Meier plots were used to calculate the actuarial local tumor control rates and rate of recurrence following GKRS. Univariate analysis, including log rank test and Wilcoxon test were used on the Kaplan-Meier plots to evaluate the predictors of tumor progression. Two-tailed p value of <0.05 was considered as significant. Median follow-up was 64months (2-184). Median tumor volume pre-GKRS was 946mm(3) (79-15970), while median tumor volume post-GKRS was 356mm(3) (30-5404). Complications were seen in two patients. Tumor control rates were 100% at 1year, 90% at 3years, and 85% at 5years, using the Kaplan-Meier method. There were no statistically significant univariate predictors of progression identified, although there was a trend towards successful tumor control in solid tumors (p=0.07). GKRS is an effective and safe option for treating intracranial hemangioblastoma with favorable tumor control rates.
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Affiliation(s)
- Danilo Silva
- Rose Ella Burkhardt Brain Tumor Center, Department of Neurosurgery and Radiation Oncology, Neurological Institute, Cleveland Clinic, OH 44124, USA.
| | - Mathew M Grabowski
- Rose Ella Burkhardt Brain Tumor Center, Department of Neurosurgery and Radiation Oncology, Neurological Institute, Cleveland Clinic, OH 44124, USA
| | - Rupa Juthani
- Rose Ella Burkhardt Brain Tumor Center, Department of Neurosurgery and Radiation Oncology, Neurological Institute, Cleveland Clinic, OH 44124, USA
| | - Mayur Sharma
- Rose Ella Burkhardt Brain Tumor Center, Department of Neurosurgery and Radiation Oncology, Neurological Institute, Cleveland Clinic, OH 44124, USA
| | - Lilyana Angelov
- Rose Ella Burkhardt Brain Tumor Center, Department of Neurosurgery and Radiation Oncology, Neurological Institute, Cleveland Clinic, OH 44124, USA
| | - Michael A Vogelbaum
- Rose Ella Burkhardt Brain Tumor Center, Department of Neurosurgery and Radiation Oncology, Neurological Institute, Cleveland Clinic, OH 44124, USA
| | - Samuel Chao
- Rose Ella Burkhardt Brain Tumor Center, Department of Neurosurgery and Radiation Oncology, Neurological Institute, Cleveland Clinic, OH 44124, USA
| | - John Suh
- Rose Ella Burkhardt Brain Tumor Center, Department of Neurosurgery and Radiation Oncology, Neurological Institute, Cleveland Clinic, OH 44124, USA
| | - Alireza Mohammadi
- Rose Ella Burkhardt Brain Tumor Center, Department of Neurosurgery and Radiation Oncology, Neurological Institute, Cleveland Clinic, OH 44124, USA
| | - Gene H Barnett
- Rose Ella Burkhardt Brain Tumor Center, Department of Neurosurgery and Radiation Oncology, Neurological Institute, Cleveland Clinic, OH 44124, USA
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17
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Goyal N, Agrawal D, Singla R, Kale SS, Singh M, Sharma BS. Stereotactic radiosurgery in hemangioblastoma: Experience over 14 years. J Neurosci Rural Pract 2016; 7:23-7. [PMID: 26933339 PMCID: PMC4750333 DOI: 10.4103/0976-3147.172165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Although gamma knife has been advocated for hemangioblastomas, it is not used widely by neurosurgeons. Objective: We review our experience over 14 years in an attempt to define the role of stereotactic radiosurgery (SRS) in the management of hemangioblastomas. Patients and Methods: A retrospective study was conducted on all patients of hemangioblastoma who underwent SRS at our institute over a period of 14 years (1998–2011). Gamma knife plans, clinical history, and radiology were reviewed for all patients. Results: A total of 2767 patients underwent gamma knife during the study period. Of these, 10 (0.36%) patients were treated for 24 hemangioblastomas. Eight patients (80%) had von Hippel-Lindau disease while two had sporadic hemangioblastomas. The median peripheral dose (50% isodose) delivered to the tumors was 29.9 Gy. Clinical and radiological follow-up data were available for eight patients. Of these, two were re-operated for persisting cerebellar symptoms. The remaining six patients were recurrence-free at a mean follow-up of 48 months (range 19–108 months). One patient had an increase in cyst volume along with a decrease in the size of the mural nodule. Conclusions: SRS should be the first option for asymptomatic hemangioblastomas. Despite the obvious advantages, gamma knife is not widely used as an option for hemangioblastomas.
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Affiliation(s)
- Nishant Goyal
- Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Agrawal
- Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India
| | - Raghav Singla
- Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank Sharad Kale
- Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India
| | - Bhawani Shankar Sharma
- Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India
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Bründl E, Schödel P, Ullrich OW, Brawanski A, Schebesch KM. Surgical resection of sporadic and hereditary hemangioblastoma: Our 10-year experience and a literature review. Surg Neurol Int 2014; 5:138. [PMID: 25317353 PMCID: PMC4192902 DOI: 10.4103/2152-7806.141469] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 07/30/2014] [Indexed: 11/07/2022] Open
Abstract
Background: Hemangioblastomas (HBLs) are benign neoplasms that contribute to 1-2.5% of intracranial tumors and 7-12% of posterior fossa lesions in adult patients. HBLs either evolve hereditarily in association with von Hippel–Lindau disease (vHL) or, more prevalently, as solitary sporadic tumors. Only few authors have reported on the clinical presentation and the neurological outcome of HBL. Methods: We retrospectively analyzed the clinical, radiological, surgical, and histopathologic records of 24 consecutive patients (11 men, 13 women; mean age 51.3 years) with HBL of the posterior cranial fossa, who had been treated at our center between 2001 and 2012. We reviewed the current literature, and discussed our findings in the context of previous publications on HBL. The study protocol was approved by the local ethics committee (14-101-0070). Results: Mean time to diagnosis was 14 weeks. The extent of resection (EOR) was total in 20 and near total in 4 patients. Four patients required revision within 24 h because of relevant postoperative bleeding. One patient died within 14 days. One patient required permanent shunting. At discharge, 75% of patients [n = 18, modified Rankin scale (mRS) 0-1] showed no or at least resolved symptoms. Mean follow-up was 21 months. Two recurrences were detected during follow-up. Conclusions: In comparison to other benign entities of the posterior fossa, time to diagnosis was significantly shorter for HBL. This finding indicates the rather aggressive biological behavior of these excessively vascularized tumors. In our series, however, the rate of complete resection was high, and morbidity and mortality rates were within the reported range.
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Affiliation(s)
- Elisabeth Bründl
- Department of Neurosurgery, University Medical Center Regensburg, Germany
| | - Petra Schödel
- Department of Neurosurgery, University Medical Center Regensburg, Germany
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19
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Puataweepong P, Dhanachai M, Hansasuta A, Dangprasert S, Sitathanee C, Puddhikarant P, Jiarpinitnun C, Ruangkanchanasetr R, Dechsupa P, Pairat K. The clinical outcome of intracranial hemangioblastomas treated with linac-based stereotactic radiosurgery and radiotherapy. JOURNAL OF RADIATION RESEARCH 2014; 55:761-768. [PMID: 24554558 PMCID: PMC4099993 DOI: 10.1093/jrr/rrt235] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/10/2013] [Accepted: 12/30/2013] [Indexed: 06/03/2023]
Abstract
Recent publications have reported stereotactic radiosurgery as an effective and safe treatment for intracranial hemangioblastomas. However, because of the low incidence of these particular tumors, reports on large patient number studies have not yet been available. The objective of this study was to analyze the clinical results of 14 patients with 56 intracranial hemangioblastomas treated with linear accelerator (linac)-based stereotactic radiosurgery (SRS) and radiotherapy (SRT) in the same institute. The median age of patients was 41 years (range, 28-73 years). Nine of the patients (64%) had von Hippel-Lindau disease. A total of 39 lesions (70%) were treated with CyberKnife (CK), and 17 lesions (30%) were treated with X-Knife. The median pretreatment volume was 0.26 cm(3) (range, 0.026-20.4 cm(3)). The median marginal dose was 20 Gy (range, 10-32 Gy) in 1 fraction (range, 1-10 fractions). The median follow-up time was 24 months (range, 11-89 months). At the last follow-up, 47 tumors (84%) were stable, 7 (13%) decreased and 2 (4%) increased. The 1-, 2- and 6-year local control rates were 98%, 88% and 73%, respectively. No radiation complications were observed in this study. There was a trend toward local failure only in cystic tumors, but this trend was not found to be statistically significant. SRS/SRT achieved a high local control rate in intracranial hemangioblastomas without radiation-induced complications.
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Affiliation(s)
- Putipun Puataweepong
- Radiation and Oncology Unit, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi, Bangkok, Thailand
| | - Mantana Dhanachai
- Radiation and Oncology Unit, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi, Bangkok, Thailand
| | - Ake Hansasuta
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi, Bangkok 10400, Thailand
| | - Somjai Dangprasert
- Radiation and Oncology Unit, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi, Bangkok, Thailand
| | - Chomporn Sitathanee
- Radiation and Oncology Unit, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi, Bangkok, Thailand
| | - Parmon Puddhikarant
- Radiation and Oncology Unit, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi, Bangkok, Thailand
| | - Chuleeporn Jiarpinitnun
- Radiation and Oncology Unit, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi, Bangkok, Thailand
| | - Rawee Ruangkanchanasetr
- Radiation and Oncology Unit, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi, Bangkok, Thailand
| | - Patchareporn Dechsupa
- Radiosurgery Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi, Bangkok 10400, Thailand
| | - Kumutinee Pairat
- Radiosurgery Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi, Bangkok 10400, Thailand
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20
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Sankaredja J, Brac B, Thines L, Baroncini M, Zairi F, Cardot-Bauters C, Lejeune JP. [Epidemiology, treatment and follow-up of central nervous system hemangioblastomas in von Hippel-Lindau disease]. Rev Neurol (Paris) 2014; 170:288-96. [PMID: 24680832 DOI: 10.1016/j.neurol.2013.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 12/07/2013] [Accepted: 12/20/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Central nervous system (CNS) hemangioblastomas (HGB) are rare vascular tumors. The goal of this study was to analyze their epidemiology, treatment and prognosis in association with von Hippel-Lindau (VHL) disease. METHODS We retrospectively reviewed a series of patients treated in our department for a CNS HGB with VHL disease between 1996 and 2008. We analyzed pre- and postoperative clinical and radiological characteristics, number of visceral lesions (fundoscopy, abdomino-pelvian CT, metanephrines), clinical course (modified Rankin Scale and McCormick scale) and late prognosis (Kaplan-Meier survival curves). RESULTS We studied 19 cases (sex-ratio 0.9, mean age 36). The mean time to diagnosis was 61days. The main symptom was intracranial hypertension for cerebellar lesions (7/15) and a sensitive-motor deficit for medulla oblongata (2/5) or spinal lesions (5/11). Preferred locations were cerebellum (15/31), often nodulo-cystic appearance, followed by spinal cord (11/31), frequently coming with adjacent syringomyelia. Multiple locations and visceral lesions were found in two-third of the cases. Surgical removal was complete in more than three-quarter of the cases. Mean follow-up duration was 9years. Postoperative mortality rate was 16%. In cerebellar and medulla oblongata locations together, final mRS was ≤1 in 17 of the 20 cases. In spinal cord locations, final McCormick score was ≤2 in all the cases. After delayed follow-up, about two-third of patients experienced recurrence or new progressive CNS lesions. CONCLUSION HGB are rare CNS tumors. VHL disease should be considered when an HGB is diagnosed before 30, is located at the spinal cord, comes with multiple other CNS lesions or with typical peripheral lesions. Microsurgical removal is the gold standard treatment and can offer good functional results.
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Affiliation(s)
- J Sankaredja
- Clinique de neurochirurgie, pôle des neurosciences et de l'appareil locomoteur, hôpital Roger-Salengro, CHRU de Lille, université Lille Nord-de-France, avenue du Pr-Émile-Laine, 59037 Lille cedex, France
| | - B Brac
- Faculté de médecine de Lille, université Lille 2 (Option Initiation à la Rédaction d'Article), 1, place de Verdun, 59000 Lille, France
| | - L Thines
- Clinique de neurochirurgie, pôle des neurosciences et de l'appareil locomoteur, hôpital Roger-Salengro, CHRU de Lille, université Lille Nord-de-France, avenue du Pr-Émile-Laine, 59037 Lille cedex, France; Faculté de médecine de Lille, université Lille 2 (Option Initiation à la Rédaction d'Article), 1, place de Verdun, 59000 Lille, France.
| | - M Baroncini
- Clinique de neurochirurgie, pôle des neurosciences et de l'appareil locomoteur, hôpital Roger-Salengro, CHRU de Lille, université Lille Nord-de-France, avenue du Pr-Émile-Laine, 59037 Lille cedex, France
| | - F Zairi
- Clinique de neurochirurgie, pôle des neurosciences et de l'appareil locomoteur, hôpital Roger-Salengro, CHRU de Lille, université Lille Nord-de-France, avenue du Pr-Émile-Laine, 59037 Lille cedex, France
| | - C Cardot-Bauters
- Service de médecine interne et d'endocrinologie, hôpital Huriez, CHRU de Lille, université Lille Nord-de-France, 1, place de Verdun, 59000 Lille, France
| | - J-P Lejeune
- Clinique de neurochirurgie, pôle des neurosciences et de l'appareil locomoteur, hôpital Roger-Salengro, CHRU de Lille, université Lille Nord-de-France, avenue du Pr-Émile-Laine, 59037 Lille cedex, France
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21
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Xie T, Zhang X, Hu F, Wang X, Wang J, Yu Y, Chen L. Suprasellar hemangioblastoma mimicking a craniopharyngioma: result of extended endoscopic transsphenoidal approach--case report. Neurol Med Chir (Tokyo) 2013; 53:735-9. [PMID: 24077270 PMCID: PMC4508754 DOI: 10.2176/nmc.cr2011-0016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Hemangioblastoma in the suprasellar region is rare. We present a case of a suprasellar hemangioblastoma that underwent surgical resection using an extended endoscopic transsphenoidal approach. A 64-year-old female patient presented with headache and decreased visual acuity for the last four years, computed tomography (CT) and magnetic resonance imaging (MRI) revealed a 2.5 cm irregular lesion in the suprasellar region. Our preoperative presumptive diagnosis was craniopharyngioma. The patient underwent an extended endoscopic transsphenoidal approach, the mass was subtotally removed. An endoscopic endonasal repair was needed due to the cerebrospinal fluid (CSF) leak. However, 1 month later, the patient got disturbance of consciousness because of the hydrocephalus. Ventriculoperitoneal shunt was used to solve the problem. Pathological findings were compatible with hemangioblastoma. Suprasellar hemangioblastoma is very rare. Any highly vascular lesions located in the suprasellar region should alert the surgeon to the possibility of hemangioblastoma. Extended endoscopic transsphenoidal approach adopted by us should not be the first choice of the treatment procedure for this kind of large and vascular tumor.
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Affiliation(s)
- Tao Xie
- Department of Neurosurgery, Zhongshan Hospital, Fudan University
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22
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Capitanio JF, Mazza E, Motta M, Mortini P, Reni M. Mechanisms, indications and results of salvage systemic therapy for sporadic and von Hippel–Lindau related hemangioblastomas of the central nervous system. Crit Rev Oncol Hematol 2013; 86:69-84. [DOI: 10.1016/j.critrevonc.2012.10.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 09/20/2012] [Accepted: 10/11/2012] [Indexed: 10/27/2022] Open
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Mills SA, Oh MC, Rutkowski MJ, Sughrue ME, Barani IJ, Parsa AT. Supratentorial hemangioblastoma: clinical features, prognosis, and predictive value of location for von Hippel-Lindau disease. Neuro Oncol 2012; 14:1097-104. [PMID: 22723428 DOI: 10.1093/neuonc/nos133] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Supratentorial hemangioblastoma is a rare form of hemangioblastoma; little information is available regarding prognosis, treatment, and clinical characteristics, because the available literature is primarily composed of case reports and small case series. Therefore, we performed a systematic review of the literature to analyze clinical characteristics, disease progression, and surgical outcomes with respect to survival for supratentorial hemangioblastomas. The rate of progression-free survival (PFS) was determined using Kaplan-Meier analysis. Differences in categorical factors, including location of tumor and diagnosis of von Hippel-Lindau (VHL) disease, were analyzed using the Pearson χ(2) test. A total of 106 articles met the search criteria, which combined for a total of 132 patients. Of the patients with supratentorial tumors, 60% had VHL disease, and 31 (84%) of 37 patients with tumors in the sellar/suprasellar region had associated VHL (χ(2), P < .001). Five-year PFS for gross-total resection and subtotal resection were 100% and 53%, respectively (Log rank, P < .01). On the basis of our analysis of the literature on published cases of supratentorial hemangioblastoma, gross-total resection appears to be superior to other treatment modalities in extending PFS. Von Hippel-Lindau disease is positively correlated with supratentorial hemangioblastoma when compared with non-supratentorial CNS hemangioblastomas, particularly when present in the sellar/suprasellar region.
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Affiliation(s)
- Steven A Mills
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
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24
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Schär RT, Vajtai I, Sahli R, Seiler RW. Manifestation of a sellar hemangioblastoma due to pituitary apoplexy: a case report. J Med Case Rep 2011; 5:496. [PMID: 21970745 PMCID: PMC3197537 DOI: 10.1186/1752-1947-5-496] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 10/04/2011] [Indexed: 11/21/2022] Open
Abstract
Introduction Hemangioblastomas are rare, benign tumors occurring in any part of the nervous system. Most are found as sporadic tumors in the cerebellum or spinal cord. However, these neoplasms are also associated with von Hippel-Lindau disease. We report a rare case of a sporadic sellar hemangioblastoma that became symptomatic due to pituitary apoplexy. Case presentation An 80-year-old, otherwise healthy Caucasian woman presented to our facility with severe headache attacks, hypocortisolism and blurred vision. A magnetic resonance imaging scan showed an acute hemorrhage of a known, stable and asymptomatic sellar mass lesion with chiasmatic compression accounting for our patient's acute visual impairment. The tumor was resected by a transnasal, transsphenoidal approach and histological examination revealed a capillary hemangioblastoma (World Health Organization grade I). Our patient recovered well and substitutional therapy was started for panhypopituitarism. A follow-up magnetic resonance imaging scan performed 16 months postoperatively showed good chiasmatic decompression with no tumor recurrence. Conclusions A review of the literature confirmed supratentorial locations of hemangioblastomas to be very unusual, especially within the sellar region. However, intrasellar hemangioblastoma must be considered in the differential diagnosis of pituitary apoplexy.
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Affiliation(s)
- Ralph T Schär
- Department of Neurosurgery, Inselspital, University Hospital Bern, 3010 Bern, Switzerland.
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Peyre M, David P, Van Effenterre R, François P, Thys M, Emery E, Redondo A, Decq P, Aghakhani N, Parker F, Tadié M, Lacroix C, Bhangoo R, Giraud S, Richard S. Natural history of supratentorial hemangioblastomas in von Hippel-Lindau disease. Neurosurgery 2011; 67:577-87; discussion 587. [PMID: 20647972 DOI: 10.1227/01.neu.0000374846.86409.a7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Supratentorial hemangioblastomas are rare lesions, occurring either sporadically or in von Hippel-Lindau disease. OBJECTIVE Following recent advances in our understanding of the natural history of von Hippel-Lindau-associated cerebellar and spinal hemangioblastomas, we conducted a study of the natural history of supratentorial hemangioblastomas in von Hippel-Lindau disease. METHODS We reviewed a series of 18 supratentorial hemangioblastomas in 13 patients with von Hippel-Lindau disease. Clinical, genetic, and serial imaging data and operative records were analyzed. RESULTS Hemangioblastomas were most commonly seen in the temporal lobe. Only 6 tumors had a cyst at diagnosis or during follow-up, and only 6 patients had associated symptoms at presentation or during follow-up. The most frequent clinical presentations were intracranial hypertension and visual loss. Of 14 tumors with documented serial imaging, 13 demonstrated tumor growth. Rates and patterns of tumor growth were unique to each patient. The mechanism of cyst formation described in other locations was also demonstrated in the supratentorial region. Patterns of peritumoral edema and rate of cyst formation seemed to be influenced by the presence of anatomic barriers. Germline VHL mutation was identified in all patients, but no specific genotype-phenotype correlation was found, although a familial predisposition is suggested. CONCLUSION This series illustrates the wide variation in tumor locations, patterns of growth, and edema progression seen in supratentorial hemangioblastomas and adds to our knowledge of the natural history of hemangioblastomas.
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Affiliation(s)
- Matthieu Peyre
- Service de Neurochirurgie, Hôpital de Bicêtre, AP-HP, Le Kremlin-Bicêtre, France.
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Beitner MM, Winship I, Drummond KJ. Neurosurgical considerations in von Hippel-Lindau disease. J Clin Neurosci 2011; 18:171-80. [PMID: 21215639 DOI: 10.1016/j.jocn.2010.04.054] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Accepted: 04/03/2010] [Indexed: 10/18/2022]
Abstract
Von Hippel-Lindau disease is an inherited syndrome predisposing to a variety of benign and malignant neoplasms of the central nervous system and viscera that requires comprehensive screening and follow-up of individuals and their families. As such, it is important for the neurosurgeon to be aware of its clinical features and management issues. In this article we review the clinical aspects, management and surveillance of von Hippel-Lindau disease for neurosurgical practice.
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Affiliation(s)
- M M Beitner
- Department of Neurosurgery, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia.
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27
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Gamma Knife Radiosurgery for Intracranial Hemangioblastomas—Outcome at 3 Years. World Neurosurg 2011; 75:99-105; discussion 45-8. [DOI: 10.1016/j.wneu.2010.09.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 08/20/2010] [Accepted: 09/25/2010] [Indexed: 11/18/2022]
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28
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Niemelä M. There Is a Role for Stereotactic Radiotherapy in Hemangioblastomas. World Neurosurg 2011. [DOI: 10.1016/j.wneu.2010.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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29
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Outcomes of gamma knife treatment for solid intracranial hemangioblastomas. J Clin Neurosci 2010; 17:706-10. [DOI: 10.1016/j.jocn.2009.09.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 09/18/2009] [Accepted: 09/21/2009] [Indexed: 11/18/2022]
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Pavesi G, Berlucchi S, Munari M, Manara R, Scienza R, Opocher G. Clinical and surgical features of lower brain stem hemangioblastomas in von Hippel-Lindau disease. Acta Neurochir (Wien) 2010; 152:287-92. [PMID: 19787293 DOI: 10.1007/s00701-009-0512-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Accepted: 09/08/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the context of von Hippel-Lindau disease (VHL), the medulla oblongata is a relatively frequent site of growth of hemangioblastomas, posing related clinical and surgical difficulties. Their management requires a close correlation between clinical evolution and morphological surveillance. In order to describe their clinical and surgical features, we reviewed our experience in the treatment of these lesions. METHODS Between 2001 and 2009, 14 patients (9 female and 5 male, mean age 34 years) underwent removal of 15 lower brain stem hemangioblastomas. Based on the review of the clinical records and outpatient long-term follow-up visits, their clinical course was analyzed. Functional evaluation was measured with the Karnofsky Performance Scale (KPS) on admission, at discharge and at the last follow-up. The mean follow-up period was 30.8 months (range 4-99). RESULTS All the operated hemangioblastomas were located in the dorsal medulla oblongata, in the context of multiple lesions, cerebellar and/or spinal. In ten patients hemangioblastomas were located in a median position at the obex area; in four cases a lateral location was observed. Cystic component was absent in two cases. Clinical onset preceded surgery by a mean of 8.5 months. Preoperatively three patients showed a KPS lower than 80, ten patients between 80 and 90, and one patient scored 100 (asymptomatic). There was no surgical mortality. Nine out of 14 patients showed a temporary surgical morbidity. One patient required a tracheostomy. At follow-up ten patients scored a KPS better than before the operation, while the other four patients remained stable. Permanent morbidity was observed in three patients. CONCLUSIONS Lower brain stem hemangioblastomas in the context of VHL show an often gradual onset of signs and symptoms except for patients who develop an obstructive hydrocephalus. Although transient surgical complications are possible, surgery provides favorable long-term results.
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Affiliation(s)
- Giacomo Pavesi
- Neurosurgery, Padua Hospital, Via Giustiniani 1, 35100 Padova, Italy.
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31
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Kim JJ, Rini BI, Hansel DE. Von Hippel Lindau syndrome. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2010; 685:228-49. [PMID: 20687511 DOI: 10.1007/978-1-4419-6448-9_22] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Von Hippel-Lindau syndrome (VHLS) is an autosomal dominant familial cancer syndrome arising from germ-line inactivation of the VHL gene on the short arm of chromosome 3. VHLS manifests in a myriad of hyper-vascular tumors of both benign and malignant nature. Incidence of VHLS is roughly 1 in 36,000 live births and has over 90% penetrance by the age of 65. Improved understanding of the natural history and biology of VHLS has led to the introduction of screening protocols, early interventions and improved treatments, all of which resulted in a substantially improved prognosis for this disease. Further details regardingvariegated molecular pathways and mechanisms ofVHLS are emerging with the subsequent advent of novel treatment protocols that are currently in clinical trials.
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Affiliation(s)
- Jenny J Kim
- Cleveland Clinic, Taussig Cancer Institute, Celveland, Ohio 44195, USA
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32
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Asthagiri AR, Mehta GU, Zach L, Li X, Butman JA, Camphausen KA, Lonser RR. Prospective evaluation of radiosurgery for hemangioblastomas in von Hippel-Lindau disease. Neuro Oncol 2009; 12:80-6. [PMID: 20150370 DOI: 10.1093/neuonc/nop018] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To determine the effectiveness of stereotactic radiosurgery (SRS) treatment to central nervous system (CNS) hemangioblastomas in von Hippel-Lindau disease (VHL), we analyzed long-term results in VHL patients treated with SRS. Patients were enrolled in a prospective VHL natural history study, undergoing SRS treatment of CNS hemangioblastomas. Treatment regimens, serial clinical evaluations, and longitudinal imaging data were analyzed. Twenty VHL patients (10 males and 10 females) underwent SRS treatment of 44 CNS hemangioblastomas (39 cerebellar and 5 brainstem). Mean (+/-SD) age at treatment was 37.5 +/- 12.0 years (range: 13-67). Mean follow-up was 8.5 +/- 3.2 years (range: 3.0-17.6 years). All patients were alive at last follow-up. Mean treated tumor volume was 0.5 +/- 0.7 cm(3) (range: 0.01-3.6 cm(3)). Mean prescription dose was 18.9 Gy (range: 12-24 Gy) at the tumor margin. Local control rate at 2, 5, 10, and 15 years after SRS treatment was 91%, 83%, 61%, and 51%, respectively. Univariate analysis did not identify variables associated (P > .05) with worse tumor control at last follow-up. Thirty-three percent of SRS-treated small (<1.0 cm diameter), asymptomatic tumors progressed over a long-term follow-up. There were no long-term adverse radiation effects. Although SRS treatment of hemangioblastomas in VHL has a low risk for adverse radiation effects, it is associated with diminishing control over a long-term follow-up. These results indicate that SRS should not be used to prophylactically treat asymptomatic tumors and should be reserved for the treatment of tumors that are not surgically resectable.
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Affiliation(s)
- Ashok R Asthagiri
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892-1414, USA.
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33
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Moss JM, Choi CYH, Adler JR, Soltys SG, Gibbs IC, Chang SD. Stereotactic radiosurgical treatment of cranial and spinal hemangioblastomas. Neurosurgery 2009; 65:79-85; discussion 85. [PMID: 19574828 DOI: 10.1227/01.neu.0000348015.51685.d2] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Stereotactic radiosurgery has been used for nearly 2 decades to treat hemangioblastomas, particularly those that are in surgically inaccessible locations or that are multiple, as is common in von Hippel-Lindau disease. There is a paucity of long-term published radiosurgical treatment outcomes, particularly for spinal lesions, in a large patient population. The purpose of this study was to provide a long-term retrospective evaluation of radiosurgical hemangioblastoma treatment effectiveness, with a special emphasis on the relatively recent use of frameless, image-guided radiosurgery in the treatment of spinal lesions. METHODS From 1991 to 2007, 92 hemangioblastomas in 31 patients, 26 with von Hippel-Lindau disease, were treated with radiosurgery (27 tumors treated with frame-based linear accelerator radiosurgery, and 67 tumors were treated with CyberKnife radiosurgery). The mean patient age was 41 years (range, 18-81 years). The radiation dose to the tumor periphery averaged 23.4 Gy (range, 12-40 Gy). The mean tumor volume was 1.8 cm (range, 0.058-65.4 cm). Tumor response was evaluated in serial, contrast-enhanced, computed tomographic, and magnetic resonance imaging scans. RESULTS Clinical and radiographic follow-up data were available for 82 hemangioblastoma tumors. Only 13 (16%) of the treated hemangioblastomas progressed, whereas 18 tumors (22%) showed radiographic regression, and 51 tumors (62%) remained unchanged in size. With median follow-up of 69 months (range, 5-164 months), the actuarial local control rates at 36 and 60 months were 85% and 82%, respectively. Radiosurgery improved lesion-associated symptoms in 36 of 41 tumors. During the follow-up period, 9 patients died of causes unrelated to the progression of their treated hemangioblastomas, and 5 patients developed radiation necrosis. CONCLUSION Stereotactic radiosurgery is safe and effective in the treatment of hemangioblastomas and is an attractive alternative to surgery for patients, including those with von Hippel-Lindau disease.
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Affiliation(s)
- Jason M Moss
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California 94305, USA
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34
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Massive hemorrhage in hemangioblastomas. Neurosurg Rev 2009; 33:11-26. [DOI: 10.1007/s10143-009-0217-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Revised: 03/25/2009] [Accepted: 06/21/2009] [Indexed: 11/26/2022]
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Lonser RR, Butman JA, Kiringoda R, Song D, Oldfield EH. Pituitary stalk hemangioblastomas in von Hippel-Lindau disease. J Neurosurg 2009; 110:350-3. [PMID: 18834262 DOI: 10.3171/2008.4.17532] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Pituitary stalk hemangioblastomas are rare, and information on them is limited to a small number of case reports. To gain insight into the incidence, clinical effects, and management of pituitary stalk hemangioblastomas, the authors analyzed a series of patients with von Hippel-Lindau (VHL) disease. METHODS Patients with VHL disease who were enrolled in a prospective National Institutes of Health natural history study were included. Clinical, imaging, and laboratory findings were analyzed. RESULTS Two hundred fifty patients were included in the study (120 male and 130 female patients). In 8 patients (3%), 8 pituitary stalk hemangioblastomas were identified on MR imaging. This anatomical location was the most common supratentorial site for these lesions; 29% of all supratentorial hemangioblastomas were found there. The mean (+/- standard deviation) pituitary stalk hemangioblastoma volume was 0.5 +/- 0.9 cm(3) (range 0.08-2.8 cm(3)). Results of endocrine laboratory profiles were normal in all patients. All patients remained asymptomatic and none required treatment during the follow-up period (mean duration 41.4 +/- 14.4 months). CONCLUSIONS The pituitary stalk is the most common site for the development of supratentorial hemangioblastomas in patients with VHL disease. Pituitary stalk hemangioblastomas often remain asymptomatic and do not require treatment. These findings indicate that pituitary stalk hemangioblastomas in patients with VHL disease may be managed with observation and that surgery for them can be reserved until associated signs or symptoms occur.
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Affiliation(s)
- Russell R Lonser
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA.
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36
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Barton JC, Goncalves E, Santani A, Chandra-Sekar B, Morris EC, Carter BB, Stolle CA. Hypogonadotrophic hypogonadism due to intrasellar hemangioblastoma in von Hippel-Lindau syndrome. Am J Med Genet A 2009; 149A:549-51. [PMID: 19215058 DOI: 10.1002/ajmg.a.32698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- James C Barton
- Department of Medicine, Brookwood Medical Center, Birmingham, Alabama 35209, USA.
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Abstract
A 59-year-old woman presented with disturbance of consciousness and decreased visual acuity caused by a suprasellar mass identified on MRI. A bifrontal interhemispheric approach allowed removal of the top and lateral sides of the tumor from the wall of the third ventricle. The hypothalamus appeared to be the origin of the mass, which proved to be hemangioblastoma, a rare tumor in this location.
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Rachinger J, Buslei R, Prell J, Strauss C. Solid haemangioblastomas of the CNS: a review of 17 consecutive cases. Neurosurg Rev 2008; 32:37-47; discussion 47-8. [PMID: 18810515 DOI: 10.1007/s10143-008-0166-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2007] [Revised: 05/13/2008] [Accepted: 07/26/2008] [Indexed: 10/21/2022]
Abstract
A retrospective study on solid central nervous system haemangioblastomas was performed to characterize clinical features, treatment strategies and outcome in these rare lesions. Between 1993 and 2006 23, solid haemangioblastomas were surgically removed in 17 patients. Eight lesions were located within pons Varolii and medulla oblongata, six within the cerebellar hemispheres and three in the cerebellopontine angle. Three haemangioblastomas were located supratentorially and three within the spinal cord. All patients except two underwent pre-operative magnetic resonance imaging (MRI). Post-operative digital subtraction angiography and/or MRI was performed in all surviving patients. Except for spinal cord lesions, rather unsystematic clinical symptoms were observed. Twenty-two tumours could be resected completely. Two patients with brainstem lesions died within 10 weeks after surgery from infectious complications. Persistent new neurological deficits occurred in two patients. Three patients underwent radiosurgery prior to or following the surgical procedure. Solid haemangioblastomas represent a surgical challenge due to their arteriovenous malformation-like vascularisation and their frequent location in eloquent areas. Surgery is the therapy of choice. Circumferential dissection with devascularization and en bloc removal yields good functional results. A location within the brainstem carries the most unfavourable prognosis.
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Affiliation(s)
- Jens Rachinger
- Department of Neurosurgery, University of Halle-Wittenberg, Germany.
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Abstract
von Hippel-Lindau disease (VHL) is an autosomal-dominant neoplasia syndrome that is the result of a germline mutation of the VHL tumor suppressor gene on the short arm of chromosome 3. Patients with VHL are predisposed to develop lesions of the central nervous system and viscera. Central nervous system lesions include hemangioblastomas (the most common tumor in VHL) and endolymphatic sac tumors (ELSTs). Visceral manifestations include renal carcinomas and cysts, pancreatic neuroendocrine tumors and cysts, pheochromocytomas, and cystadenomas of the reproductive adnexal organs. Despite their benign pathology, hemangioblastomas and ELSTs are a frequent cause of morbidity and mortality in patients with VHL. Recent molecular biologic investigations into these VHL-associated central nervous system lesions provide new insight into their origin and development. Emerging data from serial imaging and clinical surveillance protocols provide insight into the natural history of these lesions. Because of the dissimilar pathobiology and clinical course between hemangioblastomas and ELSTs, the optimal management strategies for these neurologic manifestations of VHL are very different.
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Affiliation(s)
- John A. Butman
- Diagnostic Radiology Department, The Clinical Center of the National Institutes of Health, National Institutes of Health, Bethesda, Maryland
| | - W. Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Russell R. Lonser
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
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Kuntz C, Shaffrey CI, Ondra SL, Durrani AA, Mummaneni PV, Levin LS, Pettigrew DB. SPINAL DEFORMITY. Neurosurgery 2008; 63:443-50; discussion 450-1. [DOI: 10.1227/01.neu.0000313120.81565.d7] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
ABSTRACTOBJECTIVEIn this literature review, the authors analyze data from previously published studies that evaluated neutral upright spinal alignment (NUSA) from the occiput to the pelvis in asymptomatic individuals. Based on the data for NUSA in asymptomatic volunteers, a new classification is proposed for spinal deformity.METHODSA review of the English literature was conducted to identify studies evaluating NUSA from the occiput to the pelvis in asymptomatic juvenile, adolescent, adult, and geriatric volunteers. From the literature review, 17 angles and displacements were selected to depict neutral upright coronal and axial spinal alignment, and 21 angles and displacements were selected to depict neutral upright sagittal spinal alignment. Pooled estimates of the mean and variance were calculated for the angles and displacements from the articles that met inclusion criteria. A new classification of spinal deformity was then developed based on age-dependent NUSA; spinal abnormality; deformity curve location, pattern, magnitude, and flexibility; and global spinal alignment.RESULTSDespite a wide variation in the regional curves from the occiput to the pelvis in asymptomatic volunteers, global spinal alignment is maintained in a narrow range for preservation of horizontal gaze and balance of the spine over the pelvis and femoral heads.CONCLUSIONA new classification of spinal deformity is proposed that provides a structure for defining deformity of all patient ages and spinal abnormalities.
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Affiliation(s)
- Charles Kuntz
- Neuroscience Institute, Department of Neurosurgery, University of Cincinnati College of Medicine, and Mayfield Clinic & Spine Institute, Cincinnati, Ohio
| | - Christopher I. Shaffrey
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Stephen L. Ondra
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Atiq A. Durrani
- Department of Orthopedic Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Praveen V. Mummaneni
- Department of Neurosurgery, University of California at San Francisco, San Francisco, California
| | - Linda S. Levin
- Center for Biostatistical Services, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David B. Pettigrew
- Neuroscience Institute, Department of Neurosurgery, and Mayfield Clinic & Spine Institute, Cincinnati, Ohio
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Jagannathan J, Lonser RR, Smith R, DeVroom HL, Oldfield EH. Surgical management of cerebellar hemangioblastomas in patients with von Hippel–Lindau disease. J Neurosurg 2008; 108:210-22. [DOI: 10.3171/jns/2008/108/2/0210] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Despite the frequency of cerebellar hemangioblastomas in von Hippel–Lindau (VHL) disease, their optimum contemporary management has not been defined, and is made complex because of the multiple, progressive, and protean nature of the tumors found in patients with this disorder. To examine modern management and outcomes of cerebellar hemangioblastomas in VHL disease, the authors reviewed findings in patients with this disease who underwent resection of cerebellar hemangioblastomas.
Methods
Consecutive patients with VHL disease who underwent surgery for cerebellar hemangioblastoma(s) at the National Institutes of Health were included. Eighty consecutive patients (44 female and 36 male patients) underwent 126 operations for removal of 164 cerebellar hemangioblastomas (age at surgery 37.8 ± 10.3 years, follow-up duration 96.0 ± 60.3 months). Serial clinical examinations, imaging studies, and operative records were analyzed.
Results
Symptoms and signs included headache (94 operations; 75%), ataxia (55%), dysmetria (29%), and hydrocephalus (28%). Although the primary objective of surgery was resection of the hemangioblastoma considered responsible for symptoms (136 of the hemangioblastomas [83%]), 28 additional hemangioblastomas (17%) were removed during the same surgeries. Tumors associated with symptoms were larger (diameter 1.8 ± 1.9 cm; volume 2.8 ± 3.4 cm3; p < 0.05) and more likely to be associated with peritumoral edema or peritumoral cysts (100% associated with edema and/or cyst; p < 0.05) than asymptomatic tumors (diameter 1.1 ± 0.9 cm; volume 0.7 ± 0.4 cm3; 18%). More tumors were located in the posterior (74%) compared with the anterior (26%) half of the cerebellum (p < 0.05). Three months after resection, symptom improvement/stabilization had occurred following 124 of the operations (98%). Preoperative hydrocephalus resolved after tumor removal in 33 cases (94%) and did not require cerebrospinal fluid diversion. Long-term imaging follow-up (61.5 ± 15.0 months) revealed no recurrences.
Conclusions
Symptoms and signs caused by cerebellar hemangioblastomas in VHL disease are associated with edema and peritumoral cyst formation/propagation and are treated safely and effectively with resection. Cerebrospinal fluid diversion is rarely necessary after complete tumor removal in patients with preoperative hydrocephalus. Cerebellar hemangioblastomas are preferentially distributed in the posterior half of the cerebellum, as they are in the brainstem and spinal cord. Tumor recurrence is avoided by meticulous extracapsular resection.
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Affiliation(s)
- Jay Jagannathan
- 1Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; and
- 2Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Russell R. Lonser
- 1Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; and
| | - Rene Smith
- 1Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; and
| | - Hetty L. DeVroom
- 1Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; and
| | - Edward H. Oldfield
- 1Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; and
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Matsunaga S, Shuto T, Inomori S, Fujino H, Yamamoto I. Gamma knife radiosurgery for intracranial haemangioblastomas. Acta Neurochir (Wien) 2007; 149:1007-13; discussion 1013. [PMID: 17712513 DOI: 10.1007/s00701-007-1274-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Accepted: 07/24/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND The results of gamma knife radiosurgery for haemangioblastomas were retrospectively studied to assess the efficacy for tumour growth control and clarify the clinical indications for gamma knife radiosurgery in these tumours. METHODS The medical records of 22 patients with 67 tumours, 12 men and 10 women aged 20-73 years (mean 51.9 years), who underwent gamma knife radiosurgery for haemangioblastomas between January 1993 and January 2006, were retrospectively reviewed. Ten patients with 54 lesions had von Hippel-Lindau disease. The mean tumour volume was 1.69 cm(3) (range 0.0097-16.4 cm(3)). Nineteen patients had undergone 1-4 open surgery procedures (mean 1.5) before gamma knife radiosurgery. Tumours without a cystic component, (the solid type), were found in 54 lesions and tumours associated with cyst, (the mural nodule with cyst type), in 13 lesions. The marginal dose was 8-30 Gy (mean 14.0 Gy). FINDINGS Follow-up magnetic resonance (MR) imaging was performed at 9-146 months (mean 63 months). The control rate for tumour growth was 83.6%. The only factor affecting tumour growth control was the presence of a cystic component at the time of gamma knife radiosurgery in both univariate and multivariate analysis. No complication such as radiation-induced peritumoural oedema or radiation necrosis occurred. CONCLUSION The presence of cystic components at the time of gamma knife radiosurgery was the only factor significantly correlated with unfavourable tumour growth control by gamma knife radiosurgery for haemangioblastomas. Gamma knife radiosurgery is effective for solid type tumours, even if the marginal dose is relatively low. Surgical removal is recommended for mural nodule with cyst type tumours, when possible.
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Affiliation(s)
- S Matsunaga
- Department of Neurosurgery, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan.
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43
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Fomekong E, Hernalsteen D, Godfraind C, D'Haens J, Raftopoulos C. Pituitary stalk hemangioblastoma: The fourth case report and review of the literature. Clin Neurol Neurosurg 2007; 109:292-8. [PMID: 17187928 DOI: 10.1016/j.clineuro.2006.11.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2006] [Revised: 11/20/2006] [Accepted: 11/23/2006] [Indexed: 11/22/2022]
Abstract
Supratentorial hemangioblastomas (HBL) have been rarely described in the literature. Herein we report the fourth case of pituitary stalk HBL diagnosed concurrently with cerebellar HBLs in a 51-year-old woman with von Hippel-Lindau disease. Complete resection of the lesion was achieved using left frontopterional craniotomy and no recurrence was observed after 8 years of follow-up. The clinical presentation, radiological features, pathological findings, and the management of this particular case are discussed in the light of the available literature. To our knowledge, this case is the only pituitary stalk HBL with total resection, and a long follow-up fully documented.
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Affiliation(s)
- Edward Fomekong
- Department of Neurosurgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
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44
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Orakcioglu B, Sakowitz OW, Perren A, Heppner FL, Yonekawa Y. An unusual case of a highly progressive supratentorial capillary haemangioblastoma - histopathological considerations. Acta Neurochir (Wien) 2007; 149:419-23. [PMID: 17294345 DOI: 10.1007/s00701-006-1100-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2006] [Accepted: 12/13/2006] [Indexed: 11/26/2022]
Abstract
We describe a case of a rapidly progressive, sporadic, non-von Hippel-Lindau (VHL) disease associated supratentorial capillary haemangioblastoma. Despite the classical histopathological presentation consisting of stromal cells and abundant capillaries, the tumour showed an unfavourable clinical course.
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Affiliation(s)
- B Orakcioglu
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.
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45
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Wang Y, Wang Y, Gao X, Wang Y. Intraoperative sonographically guided resection of hemangioblastoma in the cerebellum. JOURNAL OF CLINICAL ULTRASOUND : JCU 2006; 34:247-9. [PMID: 16673369 DOI: 10.1002/jcu.20220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
We report a case of hemangioblastoma in a 37-year-old woman. Intraoperative sonography was used to significantly reduce the duration of the intervention and ensure thorough resection of the tumor. We recommend real-time intraoperative sonography as a routine procedure in the surgical treatment of hemangioblastoma.
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Affiliation(s)
- Yi Wang
- Department of Ultrasound, Fudan University Affiliated Huashan Hospital, Shanghai, China 200040
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46
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Peker S, Kurtkaya-Yapicier O, Sun I, Sav A, Pamir MN. Suprasellar haemangioblastoma. Report of two cases and review of the literature. J Clin Neurosci 2006; 12:85-9. [PMID: 15639422 DOI: 10.1016/j.jocn.2004.02.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2003] [Accepted: 02/13/2004] [Indexed: 11/24/2022]
Abstract
We report 2 patients with suprasellar haemangioblastoma (HBL). The first, a 54-year-old man, presented with headache and gradually worsening bilateral visual field defects that had progressed to complete blindness on the right side. Computed tomography (CT) and magnetic resonance imaging (MRI) of the brain demonstrated a suprasellar mass. The mass was removed through a pterional craniotomy. The postoperative course was uneventful. He had no stigmata of von Hippel-Lindau (VHL) disease. After 5 years follow-up, vision in the left eye is normal but the right eye remains blind and MRI reveals no recurrence. The second, a 38-year-old man presented with a 2-month history of severe headaches and complete visual loss in the left eye. He had had surgery for excision of a cerebellar HBL, 5 years prior to this presentation. CT and MRI revealed a residual mass in the posterior fossa and a new suprasellar mass. He underwent craniotomy and subtotal excision of the suprasellar tumour. The histological diagnosis was HBL in both patients. HBL in the sellar and suprasellar region are rare and may be sporadic or occur in association with VHL disease. The literature is reviewed and diagnosis and treatment options discussed.
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Affiliation(s)
- Selçuk Peker
- Department of Neurosurgery, Marmara University Neurological Sciences Institute, Istanbul, Turkey.
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47
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Knisely JPS, Linskey ME. Less Common Indications for Stereotactic Radiosurgery or Fractionated Radiotherapy for Patients with Benign Brain Tumors. Neurosurg Clin N Am 2006; 17:149-67, vii. [PMID: 16793507 DOI: 10.1016/j.nec.2006.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Microsurgical resection remains the mainstay of treatment for truly benign brain tumors that can be safely resected because of the potential for permanent cure with most histologic findings, including most of the histologic findings discussed in this article. Physicians must keep in mind the indolent nature of many of the benign brain tumors and realize that many patients are likely to live out normal life spans if tumor control is achieved. Therefore, it is not sufficient simply to consider local tumor control rates and short-term toxicity risks when choosing between surgery, stereotactic radiosurgery, and fractionated radiotherapy. Patients need to be apprised of all therapeutic options and to make their decisions with all information required to evaluate the risks and benefits. For benign brain tumors, these decisions may have consequences that last for decades.
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Affiliation(s)
- Jonathan P S Knisely
- Department of Therapeutic Radiology, Yale University School of Medicine, Hunter Radiation Therapy Center, PO Box 208040, New Haven, CT 06520-8040, USA.
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48
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Cosar M, Hatiboglu MA, Iplikcioglu AC, Ozcan D. Parasagittal Leptomeningeal Hemangioblastoma-Case Report-. Neurol Med Chir (Tokyo) 2006; 46:294-7. [PMID: 16794350 DOI: 10.2176/nmc.46.294] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 50-year-old male patient presented with a rare dural supratentorial hemangioblastoma manifesting as severe headache persisting for 2 months. Neuroimaging revealed a tumoral mass localized in the right parietal lobe near the sagittal sinus. The tumor was totally excised successfully. The postoperative histological diagnosis was hemangioblastoma. Such supratentorial hemangioblastomas can easily be removed because of the arachnoid cleavage plane.
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Affiliation(s)
- Murat Cosar
- Department of Neurosurgery, Afyon Kocatepe University, Turkey
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49
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Ertas G, Altundag MB, Ucer AR, Cankal F, Altundag K. Treatment of recurrent cerebellar hemangioblastoma with external radiotherapy in a patient with von Hippel-Lindau disease: a case report and review of the literature. J Neurooncol 2005; 73:273-5. [PMID: 15980980 DOI: 10.1007/s11060-004-5179-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Von Hippel-Lindau Disease, a multisystem familial cancer syndrome, is inherited as an autosomal-dominant trait. Common manifestations of the disease are retinal, cerebellar and medullary hemangioblastomas; renal cysts and carcinomas; pancreatic cysts; pheochromocytoma; and papilllary cystadenoma of the epididym. We report the case of a 40-year-old man with type I von Hippel-Lindau disease treated with external radiotherapy for recurrent cerebellar hemangioblastoma.
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Affiliation(s)
- Gulcin Ertas
- Department of Radiation Oncology, Ankara Oncology Hospital, Ankara, Turkey
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50
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Gläsker S. Central nervous system manifestations in VHL: genetics, pathology and clinical phenotypic features. Fam Cancer 2005; 4:37-42. [PMID: 15883708 DOI: 10.1007/s10689-004-5347-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2004] [Accepted: 03/26/2004] [Indexed: 12/01/2022]
Abstract
This review focuses on CNS hemangioblastomas in von Hippel-Lindau (VHL) disease. The pathogenesis of these lesions remains unclear to date; however, biallelic inactivation of the VHL tumor suppressor gene is thought to be an important step. These benign tumors occur frequently in patients with VHL disease and produce symptoms by mass effect either by the tumor itself or an accompanying cyst or edema. Furthermore, cases of spontaneous hemorrhage have been described. Genetic testing for VHL germline mutations is recommended in all patients with hemangioblastoma and yearly screening, including MRI of the brain and spine, is recommended for all VHL disease patients. Treatment of these tumors is mainly surgical. In general, surgery is indicated in symptomatic hemangioblastomas and eventually also in asymptomatic tumors that exhibit radiographic progression. However, since most VHL disease patients harbor multiple lesions, a careful individual decision must be made in each case. The tumors can usually be completely removed by dissection in the plane between tumor and CNS tissue and coagulating and cutting of the numerous feeding vessels with low power. As long as consequent yearly surveillance is performed and lesions are adequately treated in time, the prognosis of CNS hemangioblastomas in VHL disease is good. Preoperative neurological deficit, however, will not improve after surgery in most patients. Local tumor recurrences are rare.
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Affiliation(s)
- Sven Gläsker
- Department of Neurosurgery, Albert-Ludwigs-University, 79106 Freiburg, Germany.
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