On the Horizon for Infratentorial Hemangioblastomas in Children

  • Optimizing tumor resection: Intraoperative MRI-guided neurosurgery is revolutionizing the way neurosurgical operations are performed, although its diffusion is still limited. The ability to monitor tumor resection, to adjust the surgical approach, and to update the navigational system will significantly improve the resection of critically located tumors such as posterior fossa hemangioblastomas.
  • Improving the histological diagnosis: Intraoperative confocal microscopy is emerging as a new technology able to provide real-time histopathological information (7). It could be useful to differentiate hemangioblastomas from other vascularized tumors (choroid plexus tumors, clear-cell renal carcinoma metastasis, AT/RT) and to guide the intraoperative surgical strategy.
  • Enhancing the MRI: Arterial spin labeling of hemangioblastomas has been successfully used to differentiate these tumors from metastatic tumors in adults (56). Although brain metastases are less common in children, this technology could be helpful to differentiate hemangioblastomas from renal carcinoma metastasis in patients with VHL.