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.