Gamma knife radiosurgery for hemangioblastomas.

Thirteen patients (11 males, 2 females) with cerebral hemangioblastomas (HABs) were treated with Gamma Knife radiosurgery (GKR). Four patients had multiple lesions in the brain. The remainder had a single lesion. The total number of lesions was 20. Eight cases had recurrent or residual HABs after surgery. In one case diagnosis was confirmed following surgical resection 22 months after GKR. One case was diagnosed by computed tomography (CT), magnetic resonance imaging (MRI) and digital subtraction angiography (DSA). Three patients had von Hippel Lindau (VHL) disease. The mean tumor diameter was 20 mm (range 7.5 to .55 mm). The mean margin dose was 18 Gy (range 12 to 24 Gy). In 5 cases, there was an improvement of symptoms and reduction in tumor volume. In 4 cases the tumor volume and clinical status remained unchanged. In 3 patients, there was clinical deterioration. The cause of this was an increase in tumor cyst volume in 2 cases. Subsequent surgery resulted in clinical improvement. In a third patient with multiple lesions, deterioration was the result of adverse radiation effects in the medulla oblongata. Three patients were subjected to post GKR-surgery with subsequent histopathology. In one, this was due to cyst expansion. In one, it was at the patient's insistence in the presence of a stable clinical and radiological picture. In a third patient with a temporal lobe tumor, it was because of late-developing epileptic seizures. The histopathological findings in these patients showed varying degrees of small vessel thickening and occlusion together with loss of tumor cells. The observations varied in degree according to the time between GKR and the secondary operation. These findings indicate the effectiveness of the treatment. The reduction in vascularity suggests that GKR could make subsequent surgery less hazardous. The observations of this study suggest that while GKR is not adequately reliable for the control of HAB cysts, it can be an effective treatment for solid tumors, especially those in eloquent regions.