Spontaneous Hemorrhage from Central Nervous System Hemangioblastomas.
OBJECTIVE
Hemagioblastomas are highly vascular tumors that rarely present with hemorrhage. To date, the only factor reported to possibly influence the propensity of a tumor to bleed has been its size (>1.5 cm). Here, we present our series of hemorrhagic hemangioblastomas, which includes 2 very small tumors (<1.5 cm). We propose that other factors apart from size may predispose tumors to hemorrhage.


METHODS
We conducted a retrospective analysis of 55 cases of central nervous system hemangioblastomas operated on at Harborview Medical Hospital and the University of Washington between 2004 and 2014. Demographical and clinical data were collected and analyzed to determine factors that may predispose these tumors to hemorrhage.


RESULTS
Of 55 cases, only 3 patients presented with hemorrhage (5.5%). None of the patients were von Hippel-Lindau positive. Two of the hemorrhagic tumors were less than 1.5 cm, countering previous studies in which authors proposed that hemangioblastomas that are less than 1.5 cm have essentially no risk of hemorrhage. One tumor also rebled after preoperative embolization.


CONCLUSIONS
Our series suggests that small hemangioblastomas may represent a hemorrhagic risk. We speculate that other factors, such as genetic predisposition caused by single-nucleotide polymorphisms, may play a role in hemangiobalstomas that present with rupture.
Department of Neurological Surgery, University of Washington, Seattle, Washington, USA. Electronic address: chiba@uw.edu.
Chibawanye I
CI
Ene
Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
Ryan P
RP
Morton
Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
Manuel
M
Ferreira
Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
Laligam N
LN
Sekhar
Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
Louis J
LJ
Kim
D000328:Adult; D000368:Aged; D016543:Central Nervous System Neoplasms / Q000150:complications* / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000209:etiology* / Q000628:therapy; D004621:Embolization, Therapeutic; D018325:Hemangioblastoma / Q000150:complications* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies
Hemangioblastoma; Hydrocephalus; Intraparenchymal hemorrhage; Intraventricular hemorrhage; Oncology; Subarachnoid hemorrhage; Tumor