Angioblastoma is a highly vascular differentiated benign tumor arising from the nerves of the brain and spinal cord. Most hemangioblastomas arise from a single lesion. However, in patients with a disease called “von Hippel Lindau” (VHL), hemangioblastoma is a manifestation of this genetic syndrome. There are two basic forms of hemangioblastoma, including solid and vesicular. Solid tumors are composed almost entirely of cells, while vesicular tumors are composed of a small number of cells accompanied by a large number of vesicles. As the hemangioblastoma grows, the growing tumor will compress the brain and cause neurological symptoms such as headache, limb weakness, sensory loss, balance and coordination problems, or hydranencephaly. In rare cases, the tumor may be discovered inadvertently due to symptoms or diseases that are not neurologically related. Angioblastoma can be diagnosed with contrast-injected computed tomography or magnetic resonance imaging. In these tests, hemangioblastoma appears as a bright white lesion in the brain or spinal cord after injection of contrast. Angioblastoma often resembles tumors such as meningiomas, metastatic brain tumors or vascular lesions such as arteriovenous malformations. Angiography of the brain can sometimes be used to help diagnose hemangioblastoma because these tumors have a rich vascular distribution. In von Hippel Lindau disease, hemangioblastoma is a genetic disorder inherited from one of the two parents (dominant). Therefore, when there is a family history of von Hippel Lindau disease, it is possible that the immediate offspring of the family will continue to be afflicted with the disease. There are two basic treatment options for hemangioblastoma. The first is surgery to remove the tumor that is affecting the brain or spinal cord. If the patient’s hemangioblastoma can be completely removed and is not classified as von Hippel Lindau, the patient is cured. In some patients with typical vesicular hemangioblastoma, only the solid portion of the tumor is removed, while the vesicular portion is drained during surgery and the vesicles will disappear after the tumor is removed. If the entire hemangioblastoma cannot be removed, the tumor may grow back or more vesicles may be created. Any surgery on the brain or spinal cord is invasive and carries certain risks, such as stroke, infection, complications from anesthesia, or neurological deficits. Nevertheless, with today’s neurosurgical equipment, most hemangioblastomas can be safely removed. In contrast to open brain surgery, stereotactic radiation can be used to localize and destroy hemangioblastoma. A single dose of radiation causes gradual cell death followed by natural cell shrinkage. In patients with hemangioblastoma, only the solid portion of the tumor is removed with radiation; the amount of cystic fluid is slowly reduced and eventually the vesicles become progressively smaller. In patients with von Hippel Lindau disease, many hemangioblastomas form in the brain and spinal cord over time. In this case, the patient often requires multiple surgeries during his or her lifetime. These surgeries not only add to the patient’s financial burden, but even if they are successful, they can lead to progressive disability. In these patients, stereotactic radiation surgery can be performed when the hemangioblastoma becomes symptomatic and can be performed multiple times during the lifetime of the patient, thus avoiding the need for numerous traditional open brain surgeries. There are two main disadvantages to using radiation for hemangioblastoma: First, typical radiation surgery takes six months to a year to destroy the hemangioblastoma. Therefore, if the tumor is large enough to compress normal brain tissue and cause some specific symptoms, then traditional open brain surgery is usually required. In vesicular hemangioblastoma, even after surgical treatment with high doses of radiation, the vesicles continue to produce cystic fluid for several months afterwards. If these vesicles grow larger, they can also cause symptoms. Even if the tumor is killed by radiation, these symptomatic vesicular tumors will still require surgical drainage. Second, radiation may cause immediate injury to normal brain tissue around the hemangioblastoma.