Stereotactic radiosurgery versus surgical resection for spinal hemangioblastoma: A systematic review

Spinal cord hemangioblastomas are benign vascular tumors arising sporadically in approximately 70-80% of cases. They can also be manifestations of von Hippel-Lindau (VHL) disease, as these patients will often have multiple spinal hemangioblastomas. Historically, surgical management of symptomatic intramedullary hemangioblastomas has been considered the treatment of choice. However, recently, stereotactic radiosurgery has been utilized as an adjuvant therapeutic modality, and some have suggested it may have utility as the primary treatment option for these tumors. Because of the rarity of spinal hemangioblastomas, management options, clinical outcomes, and prognostic factors have not yet been fully elucidated. The National Institutes of Health (PubMed) was queried to identify all studies describing treatment of spinal hemangioblastomas. Focus was narrowed to institutional retrospective reviews, and comparisons were drawn regarding outcomes of both stereotactic radiosurgery and surgical resection. Stereotactic radiosurgery achieves stable or reduced tumor size with relatively little adverse clinical outcome long-term. Meanwhile, surgical resection results in successful removal of the tumor with approximately 96% stable or improved long-term clinical effect. Cross-platform analysis has been challenging when comparing efficacy amongst treatment modalities for this rare tumor. For the institutional retrospective reviews that exist, researchers tend to collect and record data in a multitude of fashions, making direct comparisons problematic. As such, the authors propose use of a national registry to input data prospectively about spinal cord hemangioblastomas.