Haemangioblastomas are tumours that grow from blood vessel cells. They are low grade, very slow growing and do not spread, but they can grow in the brain stem and then they are very difficult to treat. They represent about 2% of brain tumours.
Haemangioblastoma is a slow growing tumour that is most common in ages between 20 and 40. It could appear anywhere in the brain but it is found most often in the posterior fosa area including the cerebellum and brainstem. This area is located at the lower and lower back of the brain.
Because this type of tumour involves blood vessels it can cause tearing which can then lead to bleeding in the brain.
While the causes of most brain tumours are unknown and not linked to one specific genetic disease, around a quarter of haemangioblastoma cases are directly linked to Hippel-Lindau disease. This is a genetic condition which causes vascular abnormalities and increased risk of cancer in other parts of the body.
Haemangioblastomas linked to this disease are more likely to recur after surgery.
The symptoms of the tumour depend largely on its position within the brain but are often:
If the tumour is located in the brainstem there is more chance of symptoms being severe and needing emergency attention as all the nerves going from the brain to the rest of the body pass through it. A rupture of a blood vessel will also require immediate medical attention.
To diagnose a haemangiolastoma, doctors usually get a family history to check if the tumour is linked to a genetic condition (Hippel-Lindau) and also do MRI and CT scans. In some cases, an angiography may be done to identify how blood vessels are involved.
In terms of treatment, if the tumour shows little or no growth, presents minimal side-effects and does not present a threat to surrounding structures, a patient may be put on 'watch and wait'. This means that the patient will have scans every few months without having treatment. Specialists use this approach when they think that the benefits of not starting treatment outweigh the risks. If at some point the tumour begins to grow doctors will start treatment.
Treatment for haemangioblastoma usually involves surgery to remove the tumour and gamma knife radiation. Surgery may be a two stage process, first to cut the blood flow to the tumour by severing associated blodd vessels and then removing the tumour. A recent study has shown that the ability to stop blood flow to these tumours has a lot to do with how successful the outcomes of the surgery will be.
Due to the recurrence of haemangioblastomas associated with the Hippel-Lindau condition, chemotherapy may also be considered along with the treatment methods already mentioned.
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