Cyst wall enhancement is associated with local recurrence after resection of intracranial hemangioblastoma: an exploratory retrospective cohort study.
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PURPOSE: Central nervous system hemangioblastomas usually achieve durable local control after gross-total resection (GTR), yet recurrence can occur even after apparently complete removal. We evaluated whether preoperative MRI-defined radiologic subtypes, particularly cyst wall enhancement (CWE), are associated with local recurrence in surgically treated intracranial hemangioblastomas. METHODS: We retrospectively reviewed 52 surgically treated intracranial hemangioblastomas in 49 patients between 2010 and 2025. Tumors were classified as solid (S), extratumoral cystic (Ce), intratumoral cystic (Ci), or mixed cystic (Cm) type. Primary analysis was restricted to 47 first resections, including 44 tumors treated with gross-total resection (GTR). Local recurrence after GTR was evaluated primarily using Kaplan-Meier analysis and the log-rank test. Because no recurrence occurred among CWE-negative GTR tumors, exploratory odds ratios were estimated using Firth bias-reduced penalized logistic regression. RESULTS: Among the 44 primary tumors treated with GTR, local recurrence occurred in 8 of 14 CWE-positive tumors (57.1%) and in none of 30 CWE-negative tumors (0%; Fisher exact p < 0.001). CWE-positive tumors showed significantly shorter recurrence-free survival than CWE-negative tumors (log-rank p < 0.0001). Exploratory univariable Firth regression yielded an OR of 79.77 (95% CI 8.22-10,812.87) for the association between CWE and local recurrence. CONCLUSIONS: CWE was associated with local recurrence after GTR in this exploratory retrospective cohort. CWE may provide a simple and surgically interpretable imaging feature, but its prognostic value requires validation in larger independent cohorts.