Safety and efficacy of surgical treatment for brainstem hemangioblastoma: a meta-analysis

Abstract

Brainstem hemangioblastomas are benign, highly vascular tumors located in the mesencephalon, pons, and medulla oblongata. Although surgical resection is currently considered the main therapeutic option for symptomatic lesions, evidence supporting the application of microsurgery has not been systematically assessed. This meta-analysis aims to evaluate the safety and efficacy of surgical treatment for brainstem hemangioblastomas. A comprehensive search of the PubMed, Embase, and Web of Science databases was performed to identify all English language publications reporting the outcomes of surgical treatment for brainstem hemangioblastomas. Studies from January 1990 to July 2019 with ≥ 10 cases were included. We analyzed the surgical outcomes, including gross total resection, mortality, neurological morbidity, and functional outcome according to the McCormick Scale or Karnofsky Performance Scale. Thirteen studies with 473 cases were included. The pooled proportion of gross total resection was 98% (95% confidence interval (CI), 94–100%). Overall mortality and neurological morbidity were 4 (95% CI, 2–6%) and 13% (95% CI, 7–20%), respectively. Favorable functional outcomes at the last follow-up were achieved in 85% (95% CI, 78–92%) of all patients. Improved or stable functional outcomes at long-term follow-up were achieved in 94% (95% CI, 89–97%) of patients. This meta-analysis revealed that surgical treatment for brainstem hemangioblastomas is technically feasible and effective with lasting patient benefits and cure.