Gamma knife radiosurgery in 11 hemangioblastomas

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✓ One suprasellar, one mesencephalic, and nine cerebellar hemangioblastomas were treated with the gamma knife in 10 patients (median age 48 years) in Stockholm between 1978 and 1993. Four patients had von Hippel—Lindau disease, a dominant inherited trait predisposing to multiple hemangioblastomas. Six hemangioblastomas were treated with radiotherapy at a median margin dose of 25 Gy (20–35 Gy) before 1990 and the next five with a median of 10 Gy (5–19 Gy). Computerized tomography or magnetic resonance images were available for 10 of the 11 hemangioblastomas at a median follow-up time of 26 months (4–68 months) after radiosurgery. The solid part of six hemangioblastomas shrank in a median of 30 months, whereas four hemangioblastomas were unchanged at a median of 14 months. Five hemangioblastomas had an adjoining cyst and three of these cysts had to be evacuated after radiosurgery. One solitary hemangioblastoma later developed a de novo cyst that also needed evacuation. One patient with two cerebellar hemangioblastomas (margin dose 25 Gy each) developed edema at 6 months and required a shunt and prolonged corticosteroid treatment. The combined follow-up data of the 23 hemangioblastomas in 15 patients from previous literature and the present series indicate that, first, a solitary small- or medium-sized hemangioblastoma usually shrinks or stops growing after radiosurgery. The recommended margin dose is 10 to 15 Gy. Second, the adjoining cyst often does not respond to radiosurgery but requires later, sometimes repeated evacuation.

Article Information

Address reprint requests to: Mika Niemelä, M.D., Department of Neurosurgery, Helsinki University Hospital, Topeliuksenkatu 5, 00260 Helsinki, Finland.

© AANS, except where prohibited by US copyright law.

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Figures

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    Case 7. Axial T1-weighted magnetic resonance (MR) images with gadolinium enhancement. Arrows depict the tumor. Left: An MR image showing a small solid cerebellar hemangioblastoma remnant after previous removal. Right: An MR image showing reduced tumor size 33 months after radiosurgery.

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    Case 10. Axial computerized tomography (CT) scans with contrast enhancement showing hemangioblastomas at various stages of treatment. Left: Axial CT scan showing a cystic cerebellar hemangioblastoma remnant after previous removal. Radiosurgery and stereotactic cyst aspiration were performed in the same session. Center: Axial CT scan showing unchanged solid part but refilled cyst at 6 months. Stereotactic reaspiration of the cyst was performed. Right: Axial CT scan showing almost totally obliterated solid part but refilled cyst at 25 months.

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    Case 9. Coronal T1-weighted magnetic resonance images with gadolinium enhancement showing hemangioblastoma treated with radiosurgery. Left: A cystic cerebellar hemangioblastoma, not removed because of permanent anticoagulation. Right: Unchanged solid part and slightly increased cyst volume 21 months after radiosurgery.

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    Case 5. Axial computerized tomography scans with (left and center) and without (right) contrast enhancement. Left: An incidental small solid cerebellar hemangioblastoma in a patient with von Hippel—Lindau syndrome. Center: Unchanged solid part 31 months after radiosurgery. Right: Appearance of a cyst filled with blood at 51 months.

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