Treatment strategy for giant solid hemangioblastomas in the posterior fossa: a retrospective review of 13 consecutive cases.

Abstract Objective To analyze radiological characteristics, treatment strategy, and treatment outcomes of posterior fossa giant solid hemangioblastomas (GSHBs; ≥ 4 cm in maximum diameter). Methods We performed a retrospective study on 13 consecutive patients (9 male and 4 female patients [mean age 57.5 ± 13.3 years; range 24-76 years]) with GSHB who underwent surgical resection at a single institution between 2002 and 2018. The median follow-up was 33 months (range 12-120 months). For each patient, neuroimaging findings, operative record, and treatment outcome were reviewed. Results Seven tumors (53.8%) were located within cerebellar hemispheres, 4 (30.8%) in proximity to the brainstem, 1 (7.7%) within the cerebellar vermis, and 1 (7.7%) in the cerebellopontine angle. The mean maximum diameter was 4.8 ± 0.8 cm (range 4.0-6.7 cm). Gross total resection was achieved in 11 patients (84.6%), and near-total resection (NTR) in 2 patients (15.4%). Surgical complications occurred in 5 patients (38.5%); persistent neurological deficits occurred in 2 patients (15.4%). Estimated progression-free survival rates after surgery were 92.3%, 80.8%, and 80.8% at 1, 5, and 10 years, respectively, while the estimated 1-, 5- and 10-year overall survival rates were 100%, 90% and 90%, respectively. Conclusions GSHBs are surgically challenging. The current study shows that favorable outcome can be achieved for GSHBs in the cerebellar hemispheres and vermis. For those involving the brainstem, planned NTR or STR in a piecemeal fashion can be attempted if en bloc resection is judged to be infeasible, and further intervention can be considered as needed.