Preoperative Embolization of Cerebellar Hemangioblastoma with Onyx: Report of Three Cases
An 18-year-old man presented with a month history of progressive headache. Brain MRI revealed a 5.3 × 3.8 cm sized large cystic tumor with a 2.0 × 1.6 cm sized heterogeneously enhancing mural nodule in the right cerebellum with tumor effect. Tumor effect was causing effacement and displacement of the fourth ventricle (). A diagnostic vertebral angiogram revealed early intense tumor staining in the right cerebellum from the right superior cerebellar artery with AV shunt showing a highly vascular lesion (). The patient underwent embolization of a pedicle off the hemispheric branch of the right superior cerebellar artery using Onyx, resulting in near complete resolution of the tumor blush (). Near total resection of the tumor was performed with minimal blood loss. Post embolization non-enhanced CT revealed radiopaque embolic agent, Onyx in the mural nodule. Post operative MRI revealed volume reduction over 90% of enhancing mural nodule with nearly total regression of the cystic portion. The tumor was pathologically confirmed as hemangioblastoma. After surgical resection, the patient presented gradual regression of the headache.