Disorders
We Treat
Hemangioblastoma
Hemangioblastomas are a diverse group of brain tumors which arise from
the normal "glial" cells of the brain. These cells outnumber
the "neurons" that conduct impulses and serve to provide metabolic
support to the neurons. The hemangioblastomas have specific signs and
symptoms that are primarily related to their location.
Cerebellar hemangioblastomas may cause
difficulty with gait (ataxia), co-ordination or nystagmus (oscillation
of the eyes on lateral gaze toward the side of the tumor). Larger tumors
may cause hydrocephalus. On occasion the polycythemia caused by the hemangioblastoma
may result in deep venous thrombosis or other vascular abnormality.
Temporal lobe hemangioblastomas may cause epilepsy, difficulty with speech,
or loss of memory.
Frontal lobe hemangioblastomas may cause behavioral changes, weakness
of the arms or legs, or difficulty with speech.
Occipital hemangioblastomas may cause loss of vision.
Parietal hemangioblastomas may cause loss of spatial orientation, diminished
sensation on the opposite side of the body, or inability to recognize
once familiar objects or persons.
The most important aspect of the hemangioblastoma
in determining treatment is size:
Small in size (usually less than 3 centimeters in diameter).
Deep location rendering resection difficult or hazardous.
Well demarcated on MRI.
Many patients undergo a series of treatments
for hemangioblastomas including multiple surgical resections, conventional
external beam radiotherapy and possibly systemic chemotherapy. Radiosurgery,
or the gamma knife, is a consideration even in the context of intense
prior treatments. This is because radiotherapy limits dose to the tumor,
sparing normal brain.
Hemangioblastoma is most frequent in the
35-to-45 age group. The most common site is the cerebellum. It is slow
growing and does not metastasize. This tumor causes increased intracranial
pressure and cerebellar dysfunction. Symptoms are headache, vomiting and
nausea, gait disturbance, and balance problems.
Both CT and MRI scans are capable of detecting
the hemangioblastoma. Angiography is rarely done before surgery to confirm
the diagnosis. Surgery is the treatment of choice. Incompletely removed
tumors or tumors attached to the brain stem may be treated with radiosurgery.
The decisions related to treatment for
hemangioblastomas including cerebellar hemangioblastomas and cystic hemangioblastomas,
depend upon the complete understanding of the competing risks vs. benefits
for the different treatments. Options for hemangioblastoma treatment may
include surgery, radiosurgery and gamma knife. The important considerations
include the size and rate of growth of the hemangioblastoma as well as
the progression of any symptoms.
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