Cerebellar Hemangioblastoma: Clinical Presentations and Surgical Outcome

Kim, Choong Hyun; Bak, Kwoang Hum; Kim, Jae Min; Kim, Young Soo; Ko, Yong; Oh, Suck Jun; Kim, Kwang Myung; Kim, Nam Kyu

Abstract

In order to analyze clinical presentations and surgical outcome, we studied eleven cases of cerebellar hemangioblastomas from among a series of 421 intracranial tumors treated over a period of seven years. The proportion of male patients was 2.7 times that of females and the age peak appeared between 30 and 50 years(mean age: 37.7 years old). The common clinical presentations were headache(73%), dizziness(55%), unilateral cerebellar dysfunction(45%), and nausea or vomiting(36%). In our series there were two cases of cranial nerve palsy associated with von Hippel-Lindau(VHL) disease. Polycythemia that normalized postoperatively appeared in two of eleven cases. Radiologic studies showed nine cystic tumors, six in the cerebellar hemisphere and three in the cerebellar vermis, and three solid tumors extended into the brain stem. After aspiration of the cyst, careful removal of the mural nodule gave good results in more than 70% of patients. Because the tumor extended into the brain stem, however, three solid lesions were resected subtotally. Postoperative complications developed in four patients, and in three of these, the lesion extended into the brain stem. In conclusion, major clinical features were due to increased intracranial pressure, and varying expression of cerebellar and cranial nerve deficits was characteristic. To determine the resectability of lesions and to minimize surgical morbidity, extremely careful clinical and neuroradiological observation is essential.