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Hemangioblastomas and Neurogenic Polyglobulia

Gläsker, Sven MD*; Krüger, Marie T. MD*; Klingler, Jan-Helge MD*; Wlodarski, Marcin MD; Klompen, Julia MD*; Schatlo, Bawarjan MD§; Hippchen, Beate PhD*; Neumann, Hartmut P.H. MD; Van Velthoven, Vera MD*

doi: 10.1227/NEU.0b013e31828ba793
Research-Human-Clinical Studies

BACKGROUND: Neurogenic polyglobulia occurs with central nervous system hemangioblastomas. Among the suggested mechanisms are extramedullary hematopoiesis in the tumor tissue and germline mutations of the von Hippel-Lindau (VHL) tumor suppressor gene.

OBJECTIVE: To determine the frequency and driving mechanisms of polyglobulia in central nervous system hemangioblastomas.

METHODS: We performed a retrospective analysis of pre- and postoperative (at 3 and 12 months) hemoglobin levels in a consecutive series of patients with hemangioblastomas operated on in our institution from 1996 to 2009. We performed molecular genetic analyses for mutations of the VHL tumor suppressor gene.

RESULTS: Preoperative hemoglobin levels were available from 164 patients. The average hemoglobin level (15.2 g/dL in males and 13.1 g/dL in females) was within normal range according to our standards. Of 22 patients with increased preoperative hemoglobin levels (>17 g/dL in males and >15 g/dL in females), 8 presented with pathological hemoglobin (>18.5 g/dL in males and >16.5 g/dL in females) according to World Health Organization criteria. Surgical removal of the hemangioblastoma resulted in a permanent cure of polyglobulia in all patients. Six of the 8 patients with pathological hemoglobin elevation carried a germline mutation of the VHL tumor suppressor gene.

CONCLUSION: Neurogenic polyglobulia occurs in a subset of patients with hemangioblastomas. This phenomenon is mostly observed in VHL mutation carriers, but also occurs in patients with sporadic hemangioblastomas. Removal of the tumor results in the permanent cure of polyglobulia. Our observations suggest that polyglobulia is an effect by the tumor itself, either due to paraneoplasia or extramedullary hematopoiesis.

ABBREVIATIONS: CNS, central nervous system

COPD, chronic obstructive pulmonary disease

Hb, hemoglobin

VHL, von Hippel-Lindau

WHO, World Health Organization

*Department of Neurosurgery, Freiburg University Medical Center, Freiburg, Germany;

Department of Pediatric Hematology and Oncology, Freiburg University Medical Center, Freiburg, Germany;

§Department of Neurosurgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland;

Department of Internal Medicine, Section for Preventive Medicine, Freiburg University Medical Center, Freiburg, Germany

Correspondence: Prof Dr Sven Gläsker, Department of Neurosurgery, Freiburg University Medical Center, Breisacher Str. 64, 79106 Freiburg, Germany. E-mail:

Received June 19, 2012

Accepted January 29, 2013

Copyright © by the Congress of Neurological Surgeons