radiologyРадиология — практикаRadiology - Practice2713-0118Центральный научно-исследовательский институт лучевой диагностики10.52560/2713-0118-2024-2-54-71radiology-511Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL RESEARCHСтереотаксическое облучение в лечении гемангиобластом ЦНС при болезни Гиппеля – Линдау: описание семейного случая и обзор литературыStereotactic Radiotherapy of VHL-Associated hemangioblastomas: A Family Case Report and Literature Reviewhttps://orcid.org/0009-0005-1143-2030ЛестроваяА. И.LestrovayaA. I.

Лестровая Арина Игоревна, врач-радиотерапевт

125047, Москва, ул. 4-я Тверская-Ямская, 16

+7 (916) 196-65-10

Lestrovaya Arina Igorevna, radiotherapist

16, st. 4-ya Tverskaya-Yamskaya, Moscow, 125047

+7 (916) 196-65-10

alestrovaya@nsi.ruhttps://orcid.org/0000-0002-4480-0275ПронинИ. Н.ProninI. N.

Пронин Игорь Николаевич, доктор медицинских наук, профессор, академик РАН

125047, Москва, ул. 4-я Тверская-Ямская, 16

+7 (916) 651-17-56

Pronin Igor Nikolaevich, MD, Ph. D, professor

16, st. 4-ya Tverskaya-Yamskaya, Moscow, 125047

+7 (916) 651-17-56

pronin@nsi.ruhttps://orcid.org/0000-0002-0976-4547ГолановА. В.GolanovA. V.

Голанов Андрей Владимирович, доктор медицинских наук, профессор, член-корреспондент РАН

125047, Москва, ул. 4-я Тверская-Ямская, 16

+7 (903) 960-87-73

Golanov Andrey Vladimirovich, MD, Ph. D, professor

16, st. 4-ya Tverskaya-Yamskaya, Moscow, 125047

+7 (903) 960-87-73

golanov@nsi.ruhttps://orcid.org/0000-0002-8924-7346БаталовА. И.BatalovA. I.

Баталов Артем Игоревич, кандидат медицинских наук

125047, Москва, ул. 4-я Тверская-Ямская, 16

+7 (916) 066-20-50

Batalov Artem Igorevich, Ph. D.

16, st. 4-ya Tverskaya-Yamskaya, Moscow, 125047

+7 (916) 066-20-50

abatalov@nsi.ruhttps://orcid.org/0000-0003-3470-5802АнтипинаН. А.AntipinaN. A.

Антипина Наталия Анатольевна, медицинский физик

125047, Москва, ул. 4-я Тверская-Ямская, 16

+7 (903) 774-48-39

Antipina Natalia Anatolievna, medical physicist

16, st. 4-ya Tverskaya-Yamskaya, Moscow, 125047

+9 (037) 74-48-39

nantipina@nsi.ruhttps://orcid.org/0009-0007-1614-3208ДанилинаИ. И.DanilinaI. I.

Данилина Ирина Игоревна, медицинский физик

125047, Москва, ул. 4-я Тверская-Ямская, 16

+7 (915) 876-86-08

Danilina Irina Igorevna, medical physicist

16, st. 4-ya Tverskaya-Yamskaya, Moscow, 125047

+7 (915) 876-86-08

danilinaII@nsi.ruФГАУ «Национальный медицинский исследовательcкий центр нейрохирургии им. ак. Н. Н. Бурденко» Минздрава РоссииРоссияBurdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian FederationRussian Federation202427022024025471Copyright © Лестровая А.И., Пронин И.Н., Голанов А.В., Баталов А.И., Антипина Н.А., Данилина И.И., 20242024Лестровая А.И., Пронин И.Н., Голанов А.В., Баталов А.И., Антипина Н.А., Данилина И.И.Lestrovaya A.I., Pronin I.N., Golanov A.V., Batalov A.I., Antipina N.A., Danilina I.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.radp.ru/jour/article/view/511

Болезнь Гиппеля — Линдау (БГЛ) представляет собой аутосомно-доминантный опухолевый синдром, возникающий в результате мутаций с потерей функции гена VHL и ассоциированный с опухолями различной локализации.

Гемангиобластома (ГАБ, ангиоретикулема), относительно редко встречающаяся доброкачественная богато васкуляризованная опухоль центральной нервной системы, является одним из наиболее частых проявлений и основной причиной заболеваемости и смертности пациентов с БГЛ, но может проявляться и в виде спорадической формы. Опухоль часто имеет кистозный компонент и множественный характер. В основном располагается субтенториально. МРТ — золотой стандарт диагностики, также для постановки правильного диагноза могут использоваться компьютерная томография и перфузионные методики.

Методом выбора этих опухолей является их хирургическое удаление. Показаниями к стереотаксическому облучению гемангиобластом, которые все время расширяются, являются небольшие асимптоматичные очаги, в том числе при множественном поражении, и остатки или рецидивы опухоли после их удаления. Радиохирургия проводится с высокой степенью эффективности контроля опухолевого роста, в том числе при пятилетнем и более наблюдении при низкой токсичности, что особенно важно для пациентов с минимально выраженной симптоматикой и у пациентов детского возраста, а также рекомендуется соматически отягощенным пациентам и при высоких рисках хирургического удаления этих новообразований в случае сложной локализации.

В статье описан семейный случай гемангиобластомы, прослеженный на протяжении нескольких поколений, приведен алгоритм ведения больных с синдромом БГЛ с рекомендациями по необходимому объему их диагностики, наблюдения и обсуждением подходов к их лечению.

Тщательный сбор семейного анамнеза, систематическое и правильное проведение генетического и диспансерного обследования, наблюдение за пациентами с БГЛ позволит своевременно установить правильный диагноз и более широко использовать метод стереотаксического облучения.

Von Hippel-Lindau syndrome (VHL) is a rare autosomal-dominant inherited cancer syndrome with different phenotypes caused by variants in the VHL gene.

Hemangioblastoma (HAB) is a benign tumor of the central nervous system and may appear as a component of VHL disease.

HAB is one of the most common manifestations and a leading cause of morbidity and mortality in patients with BGL, but can also occur as a sporadic form. This tumor often has a cystic component and is multiple in nature. Mainly located subtentorially. MRI is the gold standard for diagnosis; computed tomography and perfusion techniques can also be used to make the correct diagnosis. The definitive treatment for these lesions is surgical resection, followed by SRS if necessary. Stereotactic irradiation is the method of choice for hemangioblastomas, especially with early detection of relatively small lesions, including those with multiple lesions. Radiosurgery is carried out with a high degree of efficiency with low toxicity, which is especially important for patients with minimally severe symptoms and in pediatric patients and also is recommended to patients with limited surgical alternatives (i.e., severe medical comorbidities, surgically unresectable tumors). SRS offered a satisfactory 5-year tumor control of HHB to VHL patients.

The article describes a family case of hemangioblastoma, traced over several generations, provides an algorithm for the management of patients with VHL syndrome with recommendations for the required scope of their diagnosis, observation and discussion of approaches to their treatment.

Careful collection of family history, genetic and follow up examination carried out systematically and correctly, monitoring of patients with VHL will allow timely establishment of the correct diagnosis and more widespread use of the stereotactic irradiation method.

болезнь Гиппеля — Линдаугемангиобластомастереотаксическая радиотерапияHemangioblastomaVHL syndromeRadiotherapyReferencesMaher E. R., Neumann H. P., Richard S. Von Hippel-Lindau disease: a clinical and scientific review. Eur. J. Hum. Genet. 2011;19(6):617-623. https://doi.org/10.1038/ejhg.2010.175E.R. Maher, H.P. Neumann, S. Richard, von Hippel-Lindau disease: a clinical and scientific review, Eur. J. Hum. Genet. 19 (6) (2011) 617–623, https://doi.org/10. 1038/ejhg.2010.175Gossage L., Eisen T., Maher E. R. VHL, the story of a tumour suppressor gene. Nat. Rev. Cancer. 2015;15(1):55-64.L. Gossage, T. Eisen, E.R. Maher, VHL, the story of a tumour suppressor gene, Nat. Rev. Cancer 15 (1) (2015) 55–64,.Zhou B., Wang J., Liu S., Peng X., Hong B., Zhou J., Ma K., Zhang J., Cai L., Gong K. Hemangioblastoma Instead of Renal Cell Carcinoma Plays a Major Role in the Unfavorable Overall Survival of Von Hippel-Lindau Disease Patients. Front. Oncol. 2019;9:1037. https://doi.org/10.3389/fonc.2019.01037B. Zhou, J. Wang, S. Liu, X. Peng, B. Hong, J. Zhou, K. Ma, J. Zhang, L. Cai, K. Gong, Hemangioblastoma Instead of Renal Cell Carcinoma Plays a Major Role in the Unfavorable Overall Survival of Von Hippel-Lindau Disease Patients, Front. Oncol. 9 (2019) 1037, https://doi.org/10.3389/fonc.2019.01037. [5]Wang J.-Y., Peng S.-H., Li T., Ning X.-H., Liu S.-J., Hong B.-A., Liu J.-Y., Wu P.-J., Zhou B.-W., Zhou J.-C., Qi N.-N., Peng X., Zhang, J.-F., Ma K.-F., Cai L., Gong K. Risk factors for survival in patients with von Hippel-Lindau disease. J. Med. Genet. 2018;55(5):322-328. https://doi.org/10.1136/jmedgenet-2017-104995J.-Y.-Y. Wang, S.-H.-H. Peng, T. Li, X.-H.-H. Ning, S.-J.-J. Liu, B.-A.-A. Hong, S.-J.- Y. Liu, P.-J.-J. Wu, B.-W.-W. Zhou, B.-W.-C. Zhou, N.-N.-N. Qi, X. Peng, J.-F. Zhang, K.-F.-F. Ma, L. Cai, K. Gong, Risk factors for survival in patients with von Hippel-Lindau disease, J. Med. Genet. 55 (5) (2018) 322–328, https://doi.org/10. 1136/jmedgenet-2017-104995.Maher E. R., Yates J. R., Harries R., Benjamin C., Harris R., Moore A. T. Ferguson-Smith M. A. Clinical features and natural history of von Hippel-Lindau disease. Q J. Med. 1990;77:1151-1163Maher ER, Yates JR, Harries R et al (1990) Clinical features and natural history of von Hippel-Lindau disease. Q J Med 77:1151–1163Murro V., Lippera M., Mucciolo D. P., Canu L., Ercolino Т., De Filpo G., Giorgio D., Traficante G., Sodi A., Virgili G., Giansanti F. Outcome and genetic analysis of patients affected by retinal capillary hemangioblastoma in von Hippel Lindau syndrome. Mol. Vis. 2021;27:542-554.Murro V., Lippera M., Mucciolo D.P., Canu L., Tonino Ercolino Т.,De Filpo G..,Giorgio D,Traficante G,Sodi A.,Virgili G., Giansanti F. (2021): Outcome and genetic analysis of patients affected by retinal capillary hemangioblastoma in von Hippel Lindau syndrome. Mol Vis. (27), pp. 542–554Gläsker S., Vergauwen E., Koch C. A., Ku tikov A., Vortmeyer A. Von Hippel-Lindau disease: current challenges and fu ture prospects. Onco. Targets. Ther. 2020;13:5669-5690. https://doi.org/10.2147/OTT.S190753Glasker S., Vergauwen E., Koch C.A., Kutikov A., Vortmeyer A. (2020): Von Hippel-Lindau disease: current challenges and future prospects. Onco Targets Ther (13), pp. 5669–5690.Conway J. E., Chou D., Clatterbuck R. E., Brem H., Long D. M., Rigamonti D. Hemangioblastomas of the central ner vous system in von Hippel-Lindau synd rome and sporadic disea se. Neurosur g. 2001;48:55-62 (discussion 62–63). https://doi.org/10.1097/00006123-200101000-00009Conway JE, Chou D, Clatterbuck RE et al (2001) Hemangio- blastomas of the central nervous system in von Hippel-Lindau syndrome and sporadic disease. Neurosurgery 48:55–62 (discussion 62–63)Ammerman J. M., Lonser R. R., Dambrosia J., Butman J. A., Oldfield E. H. Long-term natural history of hemangioblastomas in patients with von Hippel-Lindau disease: implications for treatment. J. Neurosurg. 2006;105(2):248-255. https://doi.org/10.3171/jns.2006.105.2.248J.M. Ammerman, R.R. Lonser, J. Dambrosia, J.A. Butman, E.H. Oldfield, Long-term natural history of hemangioblastomas in patients with von Hippel-Lindau disease: implications for treatment, J. Neurosurg. 105 (2) (2006) 248–255, https://doi.org/ 10.3171/jns.2006.105.2.248.Sánchez-Ortega J. F., Claramonte M., Martín M., Calatayud-Pérez J. Sporadic supratentorial hemangioblastoma with meningeal affection: A case report and literature review. Surgical neurol.international. 2021;12:394. https://doi.org/10.25259/SNI_441_2021Sánchez-Ortega, Juan Francisco; Claramonte, Marta; Martín, Mónica; Calatayud-Pérez, Juan (2021): Sporadic supratentorial hemangioblastoma with meningeal affection: A case report and literature review. In Surgical neurology international 12, p. 394. DOI: 10.25259/SNI_441_2021.Lestrovaya A. I., Golanov A. V., Zolotova S. V., Antipina N. A., Kuznetsova A. S. Stereotactic irradiation for optic nerve hemangioblastoma associated with Von Hippel — Lindau disease: a case re port and literature review. Zhurnal Voprosy Neurokhirurgii Imeni N. N. Burdenko. 2023;87(5):78-84. (In Russ., In Engl.). https://doi.org/10.17116/neiro20238705178Lestrovaya AI, Golanov AV, Zolotova SV, Antipina NA, Kuznetsova AS. Stereotactic irradiation for optic nerve hemangioblastoma associated with Von Hippel—Lindau disease: a case report and literature review. Zhurnal Voprosy Neirokhirurgii Imeni N.N. Burdenko. 2023;87(5):78 84. (In Russ., In Engl.) https://doi.org/10.17116/neiro20238705178Lonser R. R., Butman J .A., Huntoon K., Asthagiri A. R., Wu T., Bakhtian K. D., Chew E. Y., Zhuang Z., Linehan W. M., Oldfield E. H. Prospective natural history study of central nervous system hemangioblastomas in von Hippel-Lindau disease. J. of Neurosurg. 2014; 120(5):1055-1062. https://doi.org/10.3171/2014.1.JNS131431K.R. Ong, E.R. Woodward, P. Killick, C. Lim, F. Macdonald, E.R. Maher, Genotype- phenotype correlations in von Hippel-Lindau disease, Hum. Mutat. 28 (2) (2007) 143–149, https://doi.org/10.1002/humu.20385.Furness H., Salfity L., Devereux J., Halliday D., Hanson H., Ruddy D. M., Uk Vhl Study Group, Shah N., Sultana G., Woodward E. R., Sandford R. N., Snape K. M., Maher E. R. (2021): Inves tigation and Management of Apparently Sporadic Central Nervous System Haemangioblastoma for Evidence of Von Hippel — Lindau Disease. Genes. (Basel). 2021; 12(9):1414 https://doi.org/10.3390/genes12091414C. Ordookhanian, P.E. Kaloostian, S.S. Ghostine, P.E. Spiess, A.B. Etame, Management Strategies and Outcomes for VHL-related Craniospinal Hemangioblastomas, J. Kidney Cancer VHL 4 (3) (2017) 37–44, https://doi.org/10. 15586/jkcvhl.2017.90.Ong K. R., Woodward E. R., Killick P., Lim C., Macdonald F., Maher E. R. Genotype-phenotype correlations in von Hippel — Lindau disease. Hum. Mutat. 2007;28 (2):143-149. https://doi.org/10.1002/humu.20385Lonser, Russell R.; Butman, John A.; Huntoon, Kristin; Asthagiri, Ashok R.; Wu, Tianxia; Bakhtian, Kamran D., Chew Emily Y, Zhuang Zhengping, Linehan W Marston, Oldfield Edward H (2014): Prospective natural history study of central nervous system hemangioblastomas in von Hippel-Lindau disease. In Journal of neurosurgery 120 (5), pp. 1055–1062. DOI: 10.3171/2014.1.JNS131431.Matsumoto M., Kodama N., Endo Y., Sakuma J., Suzuki K., Sasaki T., Murakami K., Suzuki K., Katakura T., Shishido F. Dynamic 3D-CT angiography. Am. J. Neuroradiol. 2007;28:299-304.Furness, Hugh; Salfity, Louay; Devereux, Johanna; Halliday, Dorothy; Hanson, Helen; Ruddy, Deborah M., Uk Vhl Study Group,Shah Neha, Sultana George, Woodward Emma R, Sandford Richard N,Snape Katie M,Maher Eamonn R (2021): Investigation and Management of Apparently Sporadic Central Nervous System Haemangioblastoma for Evidence of Von Hippel-Lindau Disease. In Genes 12 (9). DOI: 10.3390/genes12091414.Zhiye C., Mengqi L., Shengyuan Y., Lin M. Multi-parametric MRI Diagnoses Ce rebellar Hemangioblastoma: A Case Report [J]. Chin. Med. Sciences J. 2018; 33(3):188-193. https://doi.org/10.24920/31804Wanebo, John E.; Lonser, Russell R.; Glenn, Gladys M.; Oldfield, Edward H. (2003): The natural history of hemangioblastomas of the central nervous system in patients with von Hippel-Lindau disease. In Journal of neurosurgery 98 (1), pp. 82–94. DOI: 10.3171/jns.2003.98.1.0082.Ordookhanian C., Kaloostian P. E., Ghos tine S. S., Spiess P. E., Etame A. B Management Strategies and Outcomes for VHL-related Craniospinal Hemangioblastomas. J. Kidney Cancer VHL. 2017;4(3)37-44. https://doi.org/10.15586/jkcvhl.2017.90Huntoon K, Wu T, Elder JB et al (2016) Biological and clinical impact of hemangioblastoma-associated peritumoral cysts in von Hippel-Lindau disease. J Neurosurg 124:971–976. https://doi.org /10.3171/2015.4.JNS1533Wanebo J. E., Lonser R. R., Glenn G. M., Oldfield E. H. (2003): The natural history of hemangioblastomas of the cen tral nervous system in patients with von Hippel-Lindau disease. J. of Neurosurg. 2003;98(1):82–94. https://doi.org/10.3171/jns.2003.98.1.0082Matsumoto, M. Dynamic 3D-CT angiography / M. Matsumoto, N. Kodama, Y. Endo et al. // Am. J. Neuroradiol. – 2007. – V. 28. – P. 299–304.Huntoon K., Wu T., Elder J. B., Butman J. A., Chew E. Y., Linehan W. M., Oldfield E. H., Lonser R. R. (2016) Biologi cal and clinical impact of hemangioblastoma-associated peritumoral cysts in von Hippel-Lindau disease. J. Neurosurg. 2016; 124:971-976. https://doi.org/10.3171/2015.4.JNS1533Merhemic, Z. Diagnostics and differential diagnostics of spinal cord tumors / Z. Merhemic, M.M. Thurnher // Spinal Cord Tumors / eds K.I. Arnautovic, Z.L. Gokaskan. – Bazel: Springer Nature Switzerland, 2019. – P. 55–70 DOI: 10.24920/31804Ordookhanian C., Kaloostian P. E., Ghos tine S. S., Spiess P. E., Etame A. B. Management Strategies and Out comes for VHL-related Craniospinal Hemangioblastomas. J. Kidney Cancer VHL. 2017;4(3):37-44. https://doi.org/10.15586/jkcvhl.2017.90Osborn, A.G. Tumors, cysts, and tumorlike lesions of the spine and spinal cord / A.G. Osborn // Diagnostic Neuroradiology / ed. A.G. Osborn. – St. Louis: Mosby Year Book, 1994. – P. 895–916.Ma K., Hong B., Zhou J., Gong Y., Wang J., Liu S., Peng X., Zhou B., Zhang J., Xie H., Zhang K., Li L., Cai D., Wang Z., Cai L., Gong K. The Efficacy and Safety of Tyrosine Kinase Inhibitors for Von Hippel-Lindau Disease: A Retrospective Study of 32 Patients. Front. Oncol. 2019;9:1122. https://doi.org/10.3389/fonc.2019.01122VHL ALLIANCE (2020): Active Surveillance Guidelines. Available online at https://www.vhl.org/wp-content/uploads/2020/10/Active-Surveillance-Guidelines-2020.pdf.Wanebo J. E., Lonser R. R., Glenn G. M., Oldfield E. H.. The natural history of hemangioblastomas of the central nervous system in patients with von Hippel-Lindau disease. J. of neurosurg. 2003;98(1):82-94. https://doi.org/10.3171/jns.2003.98.1.0082M. Prokopienko, P. Kunert, A. Podgórska, A. Marchel, Surgical treatment of sporadic and von Hippel-Lindau syndrome-associated intramedullary hemangio- blastomas, Neurol. Neurochir. Pol. 50 (5) (2016) 349–355, https://doi.org/10. 1016/j.pjnns.2016.06.003.Prokopienko M., Kunert P., Podgórska A., Marchel A. Surgical treatment of sporadic and von Hippel-Lindau syndrome-associated intramedullary hemangioblastomas. Neurol. Neurochir. Pol. 2016; 50(5)349-355. https://doi.org/10.1016/j.pjnns.2016.06.003Conway JE, Chou D, Clatterbuck RE, Brem H, Long DM, Rigamonti D. (2001): Hemangioblastomas of the central nervous system in von Hippel-Lindau syndrome and sporadic disease. Neurosurgery. (48), 55–62; discussion -3.VHL ALLIANCE (2020): Active Sur veillance Guidelines. Available online at https://www.vhl.org/wp-content/uploads/2020/10/Active-Surveillance-Guidelines-2020.pdfK. Ma, B. Hong, J. Zhou, Y. Gong, J. Wang, S. Liu, X. Peng, B. Zhou, J. Zhang, H. Xie, K. Zhang, L. Li, D. Cai, Z. Wang, L. Cai, K. Gong, The Efficacy and Safety of Tyrosine Kinase Inhibitors for Von Hippel-Lindau Disease: A Retrospective Study of 32 Patients, Front. Oncol. 9 (2019) 1122, https://doi.org/10.3389/fonc.2019.01122.Golanov A. V., Antipina N. A., Kostjuchenko V. V., Trunin Yu. Yu., Krasnyansky S. A., Kozlov A. V., Usachev D. Yu. Changes in treatment paradigm for neurosurgical patients in the era of stereotactic irradiation. By the 15th anniversary of the Neuroradiosurgery in Russia. Zhurnal Voprosy Neurokhirurgii Imeni N. N. Burdenko. 2021;85(5):48-54. (In Russ., In Engl.) https://doi.org/10.17116/neiro202185051Patrice SJ, Sneed PK, Flickinger JC et al (1996): Radiosurgery for hemangioblastoma: results of a multiinstitutional experience. Int J Radiat Oncol Biol Phys (35), pp. 493–499.Patrice S. J., Sneed P. K., Flickinger J. C., Shrieve D. C., Pollock B. E., Alexander 3-rd E., Larson D. A., Kondziolka D. S., Gutin P. H., Wara W. M., McDermott M. W., Lunsford L. D., Loeffler J. S. Radiosurgery for hemangioblastoma: results of a multiinstitutional experience. J. Radiat. Oncol. Biol. Phys. 1996;35:493-499.Wang E-M, Pan L, Wang B-J et al (2005): The long-term results of gamma knife radiosurgery for hemangioblastomas of the brain. J Neurosurg (102), pp. 225–229.Wang E-M., Pan L, Wang B-J., Zhang N., Zhou L-F., Dong Y-F., Dai J-Z., Cai P-W., Chen H. The long-term results of gamma knife radiosurgery for hemangioblastomas of the brain. J. Neurosurg. 2005;102:225-229.Tago M, Terahara A, Shin M et al (2005): Gamma knife surgery for hemangioblastomas. J Neurosurg (102), pp. 171–174.Tago M., Terahara A., Shin M., Marya ma K., Kurita H., Nakagawa K., Ohto mo K. Gamma knife surgery for hemangioblastomas. J. Neurosurg. 2005;102:171-174.Kano, Hideyuki; Niranjan, Ajay; Mongia, Sanjay; Kondziolka, Douglas; Flickinger, John C.; Lunsford, L. Dade (2008): THE ROLE OF STEREOTACTIC RADIOSURGERY FOR INTRACRANIAL HEMANGIOBLASTOMAS. In Neurosurgery 63 (3), pp. 443–451. DOI: 10.1227/01.NEU.0000313120.81565.D7.Kano H., Niranjan A., Mongia S., Kondziolka D., Flickinger J. C., Lunsford L. D. The role of stereotactic radiosurgery for intracranial hemangioblastomas. Neurosurgery. 2008;63(3):443-451. https://doi.org/10.1227/01.NEU.0000313120.81565.D7Sayer, Faisal T.; Nguyen, James; Starke, Robert M.; Yen, Chun-Po; Sheehan, Jason P. (2011): Gamma knife radiosurgery for intracranial hemangioblastomas--outcome at 3 years. In World neurosurgery 75 (1), 99-105; discussion 45-8. DOI: 10.1016/j.wneu.2010.09.032.Sayer F. T., Nguyen J., Starke R. M., Yen C. P., Sheehan J. P. Gamma knife radiosurgery for intracranial heman gioblastomas outcome at 3 years. World Neurosurg . 2011;75(1):99-105 (dis cus sion 45–8). https://doi.org/10.1016/j.wneu.2010.09.032Kano, Hideyuki; Shuto, Takashi; Iwai, Yoshiyasu; Sheehan, Jason; Yamamoto, Masaaki; McBride, Heyoung L. et al. (2015): Stereotactic radiosurgery for intracranial hemangioblastomas: a retrospective international outcome study. In Journal of neurosurgery 122 (6), pp. 1469–1478. DOI: 10.3171/2014.10.JNS131602.Kano H., Shuto T., Iwai Y., Sheehan J., Yamamoto M., McBride H. L., Sato M., Serizawa T., Yomo S., Moriki A., Kohda Y., Young D., Suzuki S., Kenai H., Duma C., Kikuchi Y., Mathieu D., Akabane A., Nagano O., Kondziolka D., Lunsford L. D. Stereotactic radiosurgery for intracranial hemangioblastomas: a retrospective interna tional outcome study. J. of Neuro surg. 2015;122(6):1469-1478. https://doi.org/10.3171/2014.10.JNS131602Liebenow B, Tatter A, Dezarn WA, Isom S, Chan MD, Tatter SB. (2019): Gamma Knife stereotactic radiosurgery favorably changes the clinical course of hemangioblastoma rowth in von Hippel-Lindau and sporadic patients. J Neurooncol. (142), 471–8.Liebenow B., Tatter A., Dezarn W. A., Isom S., Chan M. D., Tatter S. B. Gamma Knife stereotactic radiosurgery favorably changes the clinical course of hemangioblastoma rowth in von Hippel-Lindau and sporadic patients. J. Neurooncol. 2019;142:471-8. https://doi.org/10.1007/s11060-019-03118-xZibly Z, Cohen ZR, Peled A, Zach L, Nissim U, Attia M, et al. (2020): Linear accelerator stereotactic radiosurgery can modulate the clinical course of Hemangioblastoma: case series and review of the literature. J Clin Neurosci. (82), pp. 162–165.Zibly Z., Cohen Z. R., Peled A., Zach L., Nissim U., Attia M., Graves C., Camphausen K., Spiegelman R. Linear accelerator stereotactic radiosurgery can modulate the clinical course of Heman gioblastoma: case series and review of the lite ratre. J. Clin. Neurosci. 2020;82:162-165. https://doi.org/10.1016/j.jocn.2020.09.026Qiu, Jianhui; Cai, Desheng; Yang, Fan; Zhou, Jingcheng; Gong, Yanqing; Cai, Lin; Gong, Kan (2020): Stereotactic radiosurgery for central nervous system hemangioblastoma in von Hippel-Lindau disease: A systematic review and meta-analysis. In Clinical neurology and neurosurgery 195, p. 105912. DOI: 10.1016/j.clineuro.2020.105912.Qiu J., Cai D., Yang F., Zhou J., Gong Y., Cai L., Gong K. Stereotactic radio surgery for central nervous system heman gioblastoma in von Hippel-Lindau disea se: A systematic review and meta-analysis. Clin. Neurol. and Neurosurg. 2020;195:105912. https://doi.org/10.1016/j.clineuro.2020.105912Pan 2018 Pan, R. Jabarkheel, Y. Huang, A. Ho, S.D. Chang, Stereotactic radiosurgery for central nervous system hemangioblastoma: systematic review and meta-analysis, J. Neurooncol. 137 (1) (2018) 11–22, https://doi.org/10.1007/s11060-017-2697-0.Pan J., Jabarkheel R., Huang Y., Ho A., Chang S. D. Stereotactic radiosurgery for central nervous system hemangioblastoma: systematic review and meta-analysis. J. Neurooncol. 2018;137(1):11-22. https://doi.org/10.1007/s11060-017-2697-0Deeks, Emma D. (2021): Belzutifan: First Approval. In Drugs 81 (16), pp. 1921–1927. DOI: 10.1007/s40265-021-01606-x.

The authors declare that there are no conflicts of interest present.