Abstract
Background Large solid hemangioblastoma in the posterior fossa has an abundant blood supply
as an arteriovenous malformation. The presence of adjacent vital neurovascular structures
makes them vulnerable and difficult to operate. Complete surgical resection is always
a challenge to the neurosurgeon.
Material and Method We share the surgical difficulties and outcome in this case series of large solid
hemangioblastomas without preoperative embolization as an adjunct. This study included
five patients (three men and two women, with a mean age of 42.2 years). Preoperative
embolization was attempted in one patient but was unsuccessful. All the patients have
headache (100%) and ataxia (100%) as an initial symptom. A ventriculoperitoneal shunt
was inserted in one case before definite surgery due to obstructive hydrocephalus.
The surgical outcome was measured using the Karnofsky Performance Status (KPS) score.
Result The tumor was excised completely in all the cases. No intra- and postoperative morbidity
occurred in four patients; one patient developed transient lower cranial nerve palsy.
Mean blood loss was 235 mL, and no intraoperative blood transfusion was needed in
any case. The mean follow-up period was 14.2 months. The mean KPS score at last follow-up
was 80.One patient had a KPS score of 60.
Conclusion Our treatment strategy is of circumferential dissection followed by en bloc excision,
which is the optimal treatment of large solid hemangioblastoma. The use of adjuncts
as color duplex sonography and indocyanine green video angiography may help complete
tumor excision with a lesser risk of complication. Preoperative embolization may not
be needed to resect large solid posterior fossa hemangioblastoma, including those
at the cerebellopontine angle location.
Keywords
solid hemangioblastoma - circumferential dissection - embolization
