Journal of Neuro-Oncology

, Volume 142, Issue 3, pp 471–478 | Cite as

Gamma Knife Stereotactic Radiosurgery favorably changes the clinical course of hemangioblastoma growth in von Hippel-Lindau and sporadic patients

  • Brittany LiebenowEmail author
  • Abigail Tatter
  • William A. Dezarn
  • Scott Isom
  • Michael D. Chan
  • Stephen B. Tatter
Clinical Study



This is the first single-institution study of its size to characterize the treatment impact and to address the question of whether hemangioblastoma treatment with Gamma Knife Stereotactic Radiosurgery (GKRS) in both sporadic and VHL patients changes the characteristic saltatory hemangioblastoma growth pattern.


The authors reviewed a single-institution tumor registry to identify patients who had received GKRS for hemangioblastomas between January 1st, 1999, and December 31st, 2017.


15 patients with 101 lesions met search criteria with a median age of first GKRS of 39.2 years (interquartile range [IQR] of 25.7–57.4 years), including 96 VHL and 5 sporadic lesions. The median time from GKRS to last follow-up was 5.4 years (IQR 2.3–11.5 years). 4 lesions (4%) and 3 patients (20%) experienced a local failure. The 1-year, 3-year, and 5-year freedom from new hemangioblastoma formation rates were 97%, 80%, and 46% respectively. Multivariate analysis revealed a reduction in tumor volume after GKRS. Several variables associated with a greater percent reduction in volume from GKRS to last follow-up: non-cystic status (p = .01), no prior craniotomy (p = .04), and follow-up time from GKRS (p < .0001).


GKRS is a successful long-term treatment option for hemangioblastomas changing the clinical course from saltatory growth to reduction in tumor volume. Non-cystic tumors and those without prior craniotomy were associated with a greater percent reduction in volume from GKRS at last follow-up.


Gamma Knife Hemangioblastoma Oncology Sporadic Stereotactic radiosurgery Von Hippel-Lindau 



Funding was provided by Comprehensive Cancer Center at Wake Forest Baptist Medical Center (Grant No. P30 CA012197-40).

Compliance with ethical standards

Conflict of interest

We have no conflict of interest to disclose.

Informed consent

informed consent was obtained from all human participants in compliance with our IRB standards.

Supplementary material

11060_2019_3118_MOESM1_ESM.docx (1 mb)
Supplementary material 1 (DOCX 1062 KB)


  1. 1.
    Beitner MM, Winship I, Drummond KJ (2011) Neurosurgical considerations in von Hippel-Lindau disease. J Clin Neurosci 18:171–180. CrossRefPubMedGoogle Scholar
  2. 2.
    Capitanio JF, Mazza E, Motta M et al (2013) Mechanisms, indications and results of salvage systemic therapy for sporadic and von Hippel–Lindau related hemangioblastomas of the central nervous system. Crit Rev Oncol Hematol 86:69–84. CrossRefPubMedGoogle Scholar
  3. 3.
    Conway JE, Chou D, Clatterbuck RE et al (2001) Hemangioblastomas of the central nervous system in von Hippel-Lindau syndrome and sporadic disease. Neurosurgery 48:55–63. CrossRefPubMedGoogle Scholar
  4. 4.
    Dornbos D, Kim HJ, Butman JA, Lonser RR (2018) Review of the neurological implications of von Hippel–Lindau disease. JAMA Neurol 75:620. CrossRefPubMedGoogle Scholar
  5. 5.
    Lonser RR, Butman JA, Huntoon K et al (2014) Prospective natural history study of central nervous system hemangioblastomas in von Hippel-Lindau disease. J Neurosurg 120:1055–1062. CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Kano H, Shuto T, Iwai Y et al (2015) Stereotactic radiosurgery for intracranial hemangioblastomas: a retrospective international outcome study. J Neurosurg 122:1469–1478. CrossRefPubMedGoogle Scholar
  7. 7.
    Park YS, Chang JH, Chang JW et al (2005) Gamma Knife surgery for multiple hemangioblastomas. J Neurosurg. CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Hanakita S, Koga T, Shin M et al (2014) The long-term outcomes of radiosurgery for intracranial hemangioblastomas. Neuro Oncol 16:429–433. CrossRefPubMedGoogle Scholar
  9. 9.
    Sayer FT, Nguyen J, Starke RM et al (2011) Gamma Knife radiosurgery for intracranial hemangioblastomas-outcome at 3 years. World Neurosurg 75:99–105. discussion 45–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Silva D, Grabowski MM, Juthani R et al (2016) Gamma Knife radiosurgery for intracranial hemangioblastoma. J Clin Neurosci 31:147–151. CrossRefPubMedGoogle Scholar
  11. 11.
    Rajaraman C, Rowe J, Walton L et al (2004) Treatment options for von Hippel-Lindau’s haemangioblastomatosis: the role of gamma knife stereotactic radiosurgery. Br J Neurosurg 18:338–342. CrossRefPubMedGoogle Scholar
  12. 12.
    Liu A, Kuhn EN, Lucas JT et al (2015) Gamma Knife radiosurgery for meningiomas in patients with neurofibromatosis Type 2. J Neurosurg 122:536–542. CrossRefPubMedGoogle Scholar
  13. 13.
    Kondziolka D, Lunsford LD, Coffey RJ, Flickinger JC (1991) Stereotactic radiosurgery of meningiomas. J Neurosurg 74:552–559. CrossRefPubMedGoogle Scholar
  14. 14.
    Kondziolka D, Lunsford LD, McLaughlin MR, Flickinger JC (1998) Long-term outcomes after radiosurgery for acoustic neuromas. N Engl J Med 339:1426–1433. CrossRefPubMedGoogle Scholar
  15. 15.
    Baskar R, Dai J, Wenlong N et al (2014) Biological response of cancer cells to radiation treatment. Front Mol Biosci 1:24. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Truman J-P, García-Barros M, Kaag M et al (2010) Endothelial membrane remodeling is obligate for anti-angiogenic radiosensitization during tumor radiosurgery. PLoS ONE 5:e12310. CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Attia A, Chan MD, Mott RT et al (2012) Patterns of failure after treatment of atypical meningioma with gamma knife radiosurgery. J Neurooncol 108:179–185. CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Calzada MJ (2010) Von Hippel-Lindau syndrome: molecular mechanisms of the disease. Clin Transl Oncol 12:160–165. CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Departments of NeurosurgeryWake Forest School of MedicineWinston-SalemUSA
  2. 2.Radiation OncologyWake Forest School of MedicineWinston-SalemUSA
  3. 3.Biostatistical SciencesWake Forest School of MedicineWinston-SalemUSA

Personalised recommendations