Hemangioblastoma Treatment
Hemangioblastoma is often treated by surgical resection and stereotactic radiosurgery. Surgical resection is considered a standard of treatment and should be offered to the patient unless the risk of operation outweighs its potential benefits ; stereotactic radiosurgery of the tumor using either a linear accelerator.
Surgical Therapy
Surgical treatment of hemangioblastomas is total resection, remove tumor with the main goal being the preservation of surrounding neural tissue. The tumors usually are well demarcated from the surrounding brain or spinal cord, but this border of separation does not contain any particular membrane or capsule. If a hemangioblastoma can be completely removed and is not associated with von Hippel Lindau disease, then a patient is cured.
The surgical approach must be wide enough to avoid compression of the healthy tissues during retraction. In the typical case of a cystic hemangioblastoma, only the solid portion of the tumor needs to be removed; the adjacent cyst that is drained during surgery, will eventually disappear once the tumor nodule is removed. Thorough evaluation of preoperative imaging studies is the key to the safest possible exposure of the tumor. In addition to MRI and CT scans, review the angiography findings to identify the principal blood supply to the tumor mass.
Radiation therapy
Radiation therapy for hemangioblastomas suggest that high-dose irradiation (4500 to 5000 rad given over 4.5 to 5 weeks) may significantly reduce the size of the tumor or at least retard its rate of growth; decrease its vascularity; and extend the symptomÂfree interval and survival time of patients. One tangible effect of radiation on the tumor, besides the decrease in size and vascularity seen on angiograms, is the resolution of erythrocytosis. However, it should be emphasized that, unlike surgical resection, radiation treatment is not curative. There is little justification for considering radiation therapy for this benign lesion in the cerebellum, spinal cord, or cerebral hemisphere. For inoperable lesions in the brain stem or for solid lesions of the cerebellum that extend into the brain stem via the cerebellar peduncles, however, radiation therapy may be the only choice.
Stereotactic radiosurgery for recurrent and multifocal hemangioblastoma involves the brain stem. Stereotactic radiosurgery offers added benefits over conventional radiation for patients with the VHL complex who are at risk of developing further lesions with time. Because the radiation is tightly focused, subsequent lesions can be treated without significantly increasing the radiation exposure of the surrounding normal brain.
The main potential complication of radiosurgery is the chance that radiation may destroy the tumor but injure the adjacent normal brain. Such damage is called radiation edema, or in severe cases, radiation necrosis. Particularly for small tumors, the likelihood of radiation injury to the brain is low.