Clinical factors predicting outcomes after surgical resection for sporadic cerebellar hemangioblastomas.

OBJECTIVE: To determine whether various clinical factors are related to long-term outcomes of patients with sporadic cerebellar hemangioblastomas.

METHODS: Subjects included 36 patients (19 men and 17 women) who underwent resection of sporadic hemangioblastoma in the cerebellum. Age at surgery ranged from 17-79 years (mean, 49.7 years). The tumor size, which was defined as the largest diameter of the lesion including the extratumoral cyst, ranged from 10-67 mm (mean, 36.4 mm). Obstructive hydrocephalus secondary to mass effect on the fourth ventricle was present in 21 (58.3%) patients preoperatively.

RESULTS: Total tumor removal was achieved in 31 of 36 patients (86%). In 4 (11%) patients with solid tumors, postoperative hematoma occurred in the removal cavity, and hematoma removal was required immediately after surgery. We followed 30 patients for >12 months after the initial surgery (mean, 72.9 months; range, 12-274 months). Recurrence of hemangioblastoma developed in 4 of 30 patients (13%) at 6 months, 17 months, 6 years, and 22 years after surgery. At the final follow-up examination, 9 (30%) of 30 patients showed some residual neurologic symptoms (poor group), whereas the remaining 21 patients showed no deficits (good group). Using univariate analysis, both age at surgery and tumor characteristics (cystic or solid) were significantly related to long-term patient outcomes (P < 0.05). However, in a multiple logistic regression analysis, only tumor characteristics were correlated with outcomes (P = 0.017). At the final follow-up examination, patients with solid tumors more frequently showed poor outcomes than patients with cystic tumors.

CONCLUSIONS: The solid configuration observed on preoperative images of sporadic cerebellar hemangioblastomas is one of the most important clinical factors related to both immediate and long-term outcomes after surgery.