Complications of Therapies for Infratentorial Hemangioblastomas in Children

Surgery

• 1–7% surgical mortality rate: Surgery for hemangioblastomas has one of the highest reported mortality rates because of the challenging location and the clinical characteristics of the tumor. Before the microscope era, the mortality rate was 40–50% of surgical cases, and it decreased to below 20–25% after the introduction of microsurgical techniques (17). The perioperative mortality rate currently is as high as 1–2% in cases of cerebellar hemangioblastoma (15) and up to 6–7% after excision of solid hemangioblastomas of the brainstem (44, 59).

• CSF leakage: Pseudomeningocele and CSF leakage are quite commonafter surgery for cerebellar hemangioblastoma.

• Brainstem injury: Cranial nerve palsy and hemiparesis are the most feared complications after excision of brainstem hemangioblastoma.

• < 2% complications from positioning: Wound infections, vascular injuries, and peripheral paresthesias due to the positioning are infrequent (< 2%).

• 0–30% incidence of GI bleeding: Postoperative gastrointestinal bleeding rate varies from 0–30% of cases (54, 59).

• Patients with VHL at greater risk: The overall complication rate is higher in patients with VHL who undergo multiple operations.

Medical

• Antiangiogenic therapy: Pruritus, arthralgia, fatigue, vomiting, nausea, diarrhea, and headache are side effects commonly related to antiangiogenic therapy.

Radiation

• Complications uncommon: No unique complications are seen in individuals with hemangioblastomas treated with radiation (19). However, radionecrosis is reported in up to 15% of the cases (35).