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Disseminated cerebellar hemangioblastoma in two patients without von Hippel-Lindau disease.
[von hippel-lindau disease]
Two
patients
who
had
received
a
total
resection
of
cerebellar
hemangioblastoma
developed
cerebrospinal
fluid
dissemination
during
a
long
-term
follow-up
period
.
We
present
this
rare
disease
with
discussion
based
on
the
literature
.
The
patients
were
two
women
aged
45
and
57
years
.
In
the
cerebellar
hemisphere
,
one
patient
had
cystic
hemangioblastoma
of
mural
nodule
type
and
the
other
had
solid
type
.
Both
the
patients
successfully
underwent
total
resection
by
craniotomy
.
They
presented
no
mutations
in
the
von
Hippel-
Lindau
disease
(
VHL
)
gene
or
lesions
in
the
other
organs
.
One
patient
developed
local
recurrence
38
months
after
the
initial
surgery
,
and
received
stereotactic
radiosurgery
.
Three
spinal
cord
tumors
developed
91
months
later
,
and
the
tumors
were
disseminated
to
the
entire
cerebrospinal
cavity
107
months
later
.
The
other
patient
developed
hydrocephalus
53
months
after
the
initial
surgery
with
tumor
tissues
disseminated
in
the
intracranial
subarachnoid
space
.
The
conditions
of
the
two
patients
gradually
aggravated
despite
treatment
with
ventriculo-peritoneal
shunt
and
irradiation
to
the
whole
brain
and
whole
spinal
cord
.
Cerebrospinal
fluid
dissemination
of
cerebellar
hemangioblastoma
was
found
dominantly
in
non-
VHL
patients
.
The
diagnosis
was
made
10
years
after
the
initial
surgery
.
Irradiation
therapy
was
performed
,
but
the
patients
died
about
2
years
after
the
diagnosis
was
given
.
Molecular
targeted
therapies
including
vascular
proliferation
suppression
have
been
attempted
lately
,
but
no
effective
therapy
has
been
established
.
Early
diagnosis
of
dissemination
as
well
as
combination
of
aggressive
excision
and
stereotactic
radiosurgery
are
considered
to
be
appropriate
for
current
interventions
.
Diseases
Validation
Diseases presenting
"hydrocephalus"
symptom
achondroplasia
alexander disease
canavan disease
congenital toxoplasmosis
harlequin ichthyosis
hirschsprung disease
homocystinuria without methylmalonic aciduria
hydrocephalus with stenosis of the aqueduct of sylvius
krabbe disease
monosomy 21
proteus syndrome
severe combined immunodeficiency
sneddon syndrome
von hippel-lindau disease
wiskott-aldrich syndrome
This symptom has already been validated