Staged multi-modality treatment approaches for giant cerebellopontine angle hemangioblastomas

•HBs in the CPA are rare and challenging intracranial tumors.•Traditional en bloc resection may present unacceptable risks for giant CPA HBs.•Piecemeal resection may be safely feasible after substantial tumor devascularization in carefully selected patients.•Staged, multi-modality approaches may les...

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Bibliographic Details
Published in:Journal of clinical neuroscience 2018-07, Vol.53, p.224-228
Main Authors: Staudt, Michael D., Hebb, Matthew O.
Format: Article
Language:English
Subjects:
Brain tumor
Cerebellar Neoplasms - pathology
Cerebellar Neoplasms - surgery
Cerebellopontine angle
Cerebellopontine Angle - pathology
Combined Modality Therapy - methods
Embolization
Female
Hemangioblastoma - pathology
Hemangioblastoma - surgery
Humans
Middle Aged
Neurosurgical Procedures - methods
Radiosurgery
Retrospective Studies
Staging
Treatment Outcome
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Summary:•HBs in the CPA are rare and challenging intracranial tumors.•Traditional en bloc resection may present unacceptable risks for giant CPA HBs.•Piecemeal resection may be safely feasible after substantial tumor devascularization in carefully selected patients.•Staged, multi-modality approaches may lessen treatment risk of complex CPA HBs. Giant hemangioblastomas (HBs) located in the cerebellopontine angle (CPA) present rare, high risk neurosurgical challenges. En bloc resection has been traditionally recommended for HBs, however this approach may pose unacceptable risk with giant tumors. Alternative treatment strategies have not been well described and the relevant literature is scant. This case review includes an illustrative patient with a giant, symptomatic CPA HB. It was felt that the neurovascular and tumor attributes were favorable for a multi-modality treatment strategy rather than circumferential dissection to remove this formidable tumor. A staged approach consisting of preoperative HB devascularization, debulking and piecemeal resection followed by radiosurgery for a small residuum produced an excellent clinical outcome. Variations of this unconventional multi-modality strategy may reduce the perioperative morbidity of carefully selected patients with giant CPA HBs. A thorough literature review is provided.
ISSN:0967-5868
1532-2653
DOI:10.1016/j.jocn.2018.04.027