Preoperative Embolization of Cerebellar Hemangioblastoma with Onyx: Report of Three Cases
A 43-year-old man presented with a three day history of progressive headache. Brain MRI revealed a 2.7 × 2.5 cm sized posterior fossa tumor showing significant enhancement with multiple signal void vascular structures within the tumor (). The differential diagnosis included hemangioblastoma, metastasis and high grade glioma. A diagnostic vertebral angiogram demonstrated a significant vascular blush supplied mostly from the right superior cerebellar artery. There was obvious arteriovenous (AV) shunt showing a highly vascular lesion, consistent with a hemangioblastoma (). The patient underwent embolization of core feeder vessel originated off the right superior cerebellar artery using Onyx, resulting near complete resolution of the tumor blush (). Near total resection of the tumor was performed without excessive bleeding or other complication. Post-operative MRI revealed volume reduction over 90% with nearly total regression of the tortuous flow voids. The tumor was pathologically confirmed as hemangioblastoma. Histological examination of the excised tumor revealed that the hemangioblastoma was composed of stromal cells, which showed characteristically large and vacuolated appearance, and abundant vascular cells, such as endothelial cells and pericytes. Nidus vessels were occluded with thrombus and black colored embolic material, Onyx (). After surgical resection, the patient presented gradual regression of the headache.