There are areas of the brain, like the optic chiasm, where SR is not the right technique. If a tumor is close to the surface of the brain, is very approachable with open surgery, and the risk of injury to healthy brain tissue is relatively low, then open surgery is still a good option. Dr. Nauta is finding good results from spacing out the treatment, to decrease the swelling effect. Dr. Robert Welch presented a history of VHL in the retina, and his own patients with VHL over his career, with a series of fascinating drawings of retinas which he and others had made of their patients before retinal photography was in widespread use. Dr. Emily Chew shared her observations from working with hundreds of people with VHL in the NCI VHL Clinic.
Small lesions are easy to treat successfully while large lesions are notoriously difficult to treat.
If the tumor is located on the optic nerve, treatment is particularly difficult. Fortunately, tumors on the optic nerve may remain asymptomatic for long periods of time. For people at risk for developing VHL, she recommends a dilated eye examination at least once a year. Good vision can be maintained in many affected people, especially if the lesions are detected and treated early. The level of perceived discrimination points to the need for more information to determine the extent and scope of the problem.