The value of neuronavigation will decrease as the lesion gets larger, since it will be easier to find anyway. And its value will decrease as the cystic component gets larger, since intraoperative emptying of the cyst will induce more brainshift. In conclusion, neuronavigation is considered to be a valuable new adjunct in neurosurgery, known to have its own specific limitations and advantages. The technique has limited value for the large, predominantly cystic, hemangioblastomas that may occur in the cerebellum of VHL patients, but these operations are usually not that difficult. Its value is especially clear when open surgery is intended for deep-seated small intracranial hemangioblastomas.
Lesions located in the brainstem still pose the biggest challenge.
In these cases stereotactic radiosurgery may play a growing role. The Netherlands 2. Department of Internal Medicine, UMC Utrecht 3. Department of Medical Genetics, UMC Utrecht 4. Go to the table of contents for this issue.