Gamma Knife Radiosurgery for Intracranial Hemangioblastomas—Outcome at 3 Years

ObjectTo define the role of Gamma Knife radiosurgery (GKRS) for the treatment of patients with hemangioblastomas.MethodsBetween 1992 and 2009, 26 hemangioblastomas in 14 patients (9 female and 5 male) were treated with GKRS. Mean age of patients at the time of treatment was 45.1 years (range 25–61). von Hippel–Lindau disease was established in 7 patients, and 7 patients had sporadic hemangioblastomas. Twenty-one tumors were solid, 4 were cystic, and 1 had both components. Four patients were treated with upfront radiosurgery, and 10 were treated following a resection. Mean tumor volume was 1.65 cm3 (range 0.08–9.02, median 1.1 cm3). Mean dose to the tumor margin was 18 Gy (range 10–25, median 18). Patients were assessed clinically and radiologically at 6- to 12-month intervals following GKRS. The median follow-up was 3 years (range 0.5–12 years). Kaplan–Meier analysis was used to assess factors predictive of tumor progression, and factors predictive in univariate analysis (P < 0.10) were entered into Cox multivariate regression analysis.ResultsOn follow-up, 4 tumors were stable in volume (15%), 14 decreased (54%), and 8 increased (31%). Local tumor control rates at 1, 5, and 10 years was 89%, 74%, and 50%, respectively. There was a trend toward tumor progression in sporadic patients (P = 0.10), women (P = 0.09), and larger tumors (P = 0.10). In patients with multiple hemangioblastomas as compared to those with only a solitary hemangioblastoma, the radiosurgically treated lesion was 7.9 times more likely to progress after GKRS treatment (P = 0.018). This remained the only significant predictor in multivarialble analysis. At the last clinical follow-up, seven patients showed no change or improvement in their symptoms and seven deteriorated.ConclusionStereotactic radiosurgery offers a reasonable rate of tumor control and preservation of neurologic function in patients with hemangioblastomas. Patients with multiple hemangioblastomas are less likely to exhibit long-term tumor control of treated lesions following radiosurgery.