Hybrid endovascular and microsurgical treatment for a large mesencephalic-cerebellar hemangioblastoma.

Jianping Song,Peiliang Li,Wei Zhu,Xiaochun Zhao,Xiaowen Wang,Yanlong Tian

doi:10.3171/2019.10.focusvid.19287

Abstract

The large intracranial hemangioblastoma is a top surgical challenge due to its nature of invading brain parenchyma, tight adherence to the pia, and rich blood supply from numerous pial vasculatures and arteries in the proximity. If the brainstem is involved in the lesion, the surgery will be more dangerous because of potential brainstem impingement. In this illustrative video, we present a case of a 54-year-old male with a large hemangioblastoma at the mesencephalic-cerebellar region, which was successfully treated by hybrid endovascular embolization and microsurgery via an occipital interhemispheric transtentorial approach with minimal intraoperative blood loss and a favorable outcome.The video can be found here: https://youtu.be/pJqFhY_Zhv0.

Highlights

0:20 This video illustrates a hybrid endovascular and microsurgical treatment for a large mesencephalic-cerebellar hemangioblastoma via an occipital interhemispheric transtentorial approach
0:46 The initial computed tomography scan showed a heterogeneous lesion with low density in the left cerebellum
A ventricular drainage with a subcutaneous Ommaya reservoir implantation was performed to relieve the hydrocephalus and normalize the intracranial pressure. This technique can be useful for further brain relaxation during the surgery, and as a fail-safe as the postoperative cerebellum or brainstem edema might cause hydrocephalus aggravation

Summary

Introduction

0:20 This video illustrates a hybrid endovascular and microsurgical treatment for a large mesencephalic-cerebellar hemangioblastoma via an occipital interhemispheric transtentorial approach. This technique can be useful for further brain relaxation during the surgery, and as a fail-safe as the postoperative cerebellum or brainstem edema might cause hydrocephalus aggravation. 1:45 Preoperative angiography confirmed the blood supply of the tumor came mainly from the left superior cerebellar artery.

Results

Conclusion