Transient Adenosine-Induced Asystole during Surgical Removal of a Giant Cerebellopontine Angle Hemangioblastoma

Objective and Importance: Transient adenosine-induced asystole is a reliable method for producing short periods of relative hypotension during surgical and endovascular procedures. This technique has been described in the treatment of complex anterior and posterior circulation aneurysms and as a means of controlling bleeding during an intraoperative aneurysmal rupture. We describe the use of intravenous adenosine-induced asystole as a means of rapidly gaining control of intraoperative bleeding during the resection of a large cerebellopontine angle hemangioblastoma in a patient who could not receive blood transfusions due to religious belief.

Clinical Presentation: A 21-year-old woman with von Hippel-Lindau disease presented with multiple intracranial and spinal hemangioblastomas. She exhibited headaches and severe gait ataxia from a large, highly vascular cerebellopontine angle hemangioblastoma compressing the brainstem. A preoperative angiogram demonstrated a hypervascular lesion supplied by branches of AICA and PICA. The patient was a Jehovah's Witness and refused transfusion of all blood products.

Intervention: A retrosigmoid craniectomy was preformed for resection of the hemangioblastoma. Given the patient's religious beliefs and the highly vascular nature of the lesion, transient adenosine-induced asystole was performed three times during the tumor resection to facilitate hemostasis while limiting blood loss and obviating the need for transfusion of blood products. A gross total resection was achieved without any postoperative neurological deficits.

Conclusion: Intraoperative adenosine represents a potential means of achieving a near immediate decrease in blood pressure that allows for safe dissection of highly vascular tumors and may minimize blood loss thereby obviating the need for transfusion of blood products.