Surgical management of large solid hemangioblastomas of the posterior fossa

From January 2000 to January 2009, 15 patients presented with large solid hemangioblastomas of the posterior fossa; eight of these patients were also diagnosed with von Hippel-Lindau (VHL) disease. Diagnostic imaging showed large vascular lesions. All 15 patients underwent surgery through a suboccipital ipsilateral, modified far-lateral, suboccipital midline or suboccipital supracerebellar approach. Preoperative embolization was attempted in seven patients. Complete removal of the tumor was performed in all patients. An overall neurological improvement was observed in 11 of the 15 patients, corresponding to 61.5%. During follow-up, six patients, all with VHL disease, developed recurrence. Two patients died of renal cell carcinoma after 1 year. Our favorable outcomes suggest that surgical resection is the optimal treatment for patients with large solid hemangioblastomas of the posterior fossa. With improved microsurgical techniques and a better understanding of the vascular pattern of this type of tumor, total microsurgical removal can be performed with low mortality.