A 15-Year Surgical Experience with Intracranial Hemangioblastomas - A Safe, Effective, and Only Somewhat Bloody Endeavor

Introduction: Intracranial hemangioblastomas are rare tumors that represent a challenging pathology due to their high vascularity and adherence. We demonstrate our institution’s 15-year experience on these rare tumors.

Methods: We conducted a retrospective review of all intracranial hemangioblastomas resected from 2007-2022 at our institution. We identified patients by reviewing patients with pathology-confirmed hemangioblastomas and excluded all non-intracranial lesions. Patient data was collected from our electronic health records with missing data excluded from analysis.

Results: We identified 56 instances of hemangioblastoma resection in 48 distinct patients. A total of 63 hemangioblastomas were removed (four patients had two hemangioblastomas resected simultaneously, one had four). Average tumor volume was 119cm3. Twenty-five patients (44.6%) were female. Average age was 46. Twenty-four patients (42.9%) had von Hippel-Lindau Syndrome. The most common presenting symptom was imbalance (53.6%) followed by headache (50%), and vertigo (21.4%). The most common location was cerebellar hemisphere (67.9%), followed by the vermis (21.4%); only two (3.6%) were supratentorial lesions. Only three (5.4%) presented with intratumoral hemorrhage. Five patients (8.9%) underwent preoperative embolization, one of which had an intra-procedural rupture requiring emergency craniotomy. Gross total resection was achieved in 44 patients (91.7%). Three patients had hematomas postoperatively (5.4%), only one required evacuation (1.8%). Eight patients (14.5%) had external ventricular drains postoperatively and two patients (10.9%) required permanent cerebrospinal fluid diversion. Six patients (10.7%) had shunts placed preoperatively. Two patients had postoperative strokes. Average follow-up was 1093 days. Twelve patients (22.2%) had neurologic changes in follow-up, most commonly nystagmus, followed by vertigo. Seven patients (12.5%) had recurrence (at an average of 1061 days postoperatively). Three underwent surgery, three continued in surveillance, and one underwent Cyberknife.

Conclusion : Surgical intervention for hemangioblastomas is safe and effective with low recurrence rates. There is a role for endovascular embolization preoperatively to limit blood loss however it is not without risk.