2019 Volume 28 Issue 8 Pages 480-490
[Purpose] To summarize the surgical indications and strategies for hemangioblastoma. [Methods] The subjects were 79 consecutive patients with hemangioblastoma who underwent surgery between 1996 and 2017. There were 11 cases of hemangioblastoma of the medulla oblongata, five cases of hemangioblastoma of the endolymphatic sac, 13 cases of hemangioblastoma of the spinal cord, and 50 cases of hemangioblastoma of the cerebellum. There were 24 patients (31%) with von Hippel-Lindau disease. Visualization of the vascular anatomy of both the feeders and the drainers of hemangioblastomas by preoperative three-dimensional computer graphics image (3DCG) has been used jointly since 2010. [Indications for treatment] Surgery is recommended even in the absence of symptoms for spinal cord tumors that are 1 cm or more in diameter or are enlarging. In principle, we recommend “wait and see” for asymptomatic tumors of the cerebellum. If they become symptomatic, surgery is indicated. However, we recommend intervention for cerebellar tumors, even though asymptomatic, if they are 2 cm or more in diameter or for cerebellar tumors or cysts that show rapid enlargement on serial imaging. Asymptomatic tumors that are located on the surface of the brainstem are also considered for early surgery. (VHL Clinical Practice Guideline 2016) [Surgical strategy] 3DCG is useful for determining the number, location, and course of perforating vessel-type feeders and drainers of hemangioblastomas. 3DCG is also effective for preoperative determination of the proximity of the lesion to the pyramidal tract, spinothalamic tract, and spinocerebellar tract.
