The value of preoperative embolization in large and giant solid cerebellar hemangioblastomas

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p> Solid cerebellar hemangioblastomas are highly vascular lesions and may cause catastrophic hemorrhage during excision. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> This retrospective study enrolled 10 patients (7 men and 3 women, with a mean age of 38.2 ± 12.5 years) with solid cerebellar hemangioblastomas. All patients had a solitary tumor and underwent surgical resection of the lesion through a suboccipital approach. The basic features, serial radiographic examinations, and operative records were analyzed. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> The most common presenting symptoms were headache (100%), ataxia (100%), and long tract manifestations (60%). Three patients had experienced failed surgery previously due to massive intraoperative bleeding. Three patients were confirmed as having Von Hippel–Lindau disease. The average size of the tumor was 40.7 ± 8.7 mm in its maximal diameter (range 25–58 mm). Total endovascular occlusion obtained in six patients, near total occlusion in three patients, and incomplete occlusion in one patient. Nine (90.0%) patients underwent gross total resection and one (10.0%) underwent partial resection. After the primary surgery, eight (80.0%) patients experienced improvement in their symptoms, two (20.0%) maintained their pre-treatment status, and none showed neurological deterioration following tumor resection. Blood loss during surgery after embolization was minimal and controllable. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> Preoperative embolization improves safety and efficacy of the microsurgical excision of such tightly located very vascular tumors. Embolization changes the concept of this lesion surgery into piecemeal removal rather than a total mass extraction technique. Liquid agents are superior to particles in obliteration of such lesions. </jats:p></jats:sec>

Intracranial hemangioblastoma - A SEER-based analysis 2004–2013

“…Similarly, pertinent surgical details are not presented. Utilization of preoperative embolization [ 21 , 22 ], tumor consistency [ 1 , 9 , 16 , 23 ], preoperative status [ 10 ], and postoperative morbidity [ 3 , 24 , 25 ] have been associated with poor outcomes in HBs. Moreover, data regarding disease progression are lacking.…”

Preoperative Embolization of Cerebellar Hemangioblastomas with a Liquid Embolic Material (NBCA) by the “Plug and Push” Technique

“…5) Furthermore, the type of hemangioblastoma is classified into two: cystic and solid based on the tumor morphology. 6) Hemangioblastomas are characterized by the presence of abundant blood vessels in the tumor parenchyma; after resection, hemostasis is sometimes difficult. Therefore, when performing tumor resection, feeders should be treated, and, as a rule, the tumor should be resected as a mass by exfoliating it from the periphery.…”

Giant Solid Cerebellar Hemangioblastoma—En Bloc Resection without Preoperative Embolization

“…Surgery for giant solid cerebellar hemangioblastomas is technically challenging as surgery for these lesions can be associated with massive blood loss, and circumferential dissection for en bloc resection of such huge lesions is difficult. 1 Sultan et al, in their series of 10 patients, reported preoperative total or near-total endovascular occlusion of giant solid cerebellar hemangioblastomas in 90% (9/10) of cases and successful resection even piece meal rather than en bloc resection with minimal blood loss. 1 As blood supply to these lesions is from critical vessels such as posterior inferior cerebellar artery (PICA), risk of vertebrobasilar infarction from thromboembolic events during endovascular embolization exist.…”

“…1 Sultan et al, in their series of 10 patients, reported preoperative total or near-total endovascular occlusion of giant solid cerebellar hemangioblastomas in 90% (9/10) of cases and successful resection even piece meal rather than en bloc resection with minimal blood loss. 1 As blood supply to these lesions is from critical vessels such as posterior inferior cerebellar artery (PICA), risk of vertebrobasilar infarction from thromboembolic events during endovascular embolization exist. 2 A high complication rate of 11.7% following preoperative embolization of intracranial hemangioblastomas was reported in a systematic review.…”

“…Surgery is the treatment of choice for these highly vascular lesions, and preoperative embolization helps in reducing the blood loss during surgery. 1 We describe a case of giant solid cerebellar hemangioblastoma that was excised en bloc without preoperative embolization.…”