Introduction: Solid hemangioblastoma of posterior fossa is a formidable surgical challenge. These are benign tumors and patient is cured if tumor is removed completely
Methods: : Retrospective analysis of 8 patients of solid hemangioblastomas of posterior fossa operated over last 3 years was done for clinical features, operative strategy and surgical outcome.
Results: All patients underwent contrast CT and contrst MRI.digital subtraction angiography was done in tumors larger than 3 cm.Preoperative embolization significantly decreased blood loss. One tumor was in medulla and others were in cerebellum.In 2 patients spinal hemangioblastoma was also removed in same procedure. Two patients required tracheostomy and ventillatory support for 1 week. Sitting position helped in precise identification of source of bleeding and kept field clear and helped in looking at ventral aspect of tumor due to gravity assisted fall of tumor. Non-sticky good quality bipolar with irrigation helps in dissection and hemostasis. Preoperative embolization allows tumor decompression in desperate circumstances. In patient of medullary hemangioblastoma ,extensive preoperative T2 signal change from pons to cervical cord ,resolved completely
Conclusions: Preoperative tumor embolization, sitting position, good quality bipolar with irrigation leads to safe removal of these benign hypervascular tumors
Patient Care: I have highlighted practical tips for safe removal of these challenging but otherwise benign and curable tutors
Learning Objectives: Understanding practical challenges a neurosurgeon faces in surgical removal of solid hemangioblastoma of posterior fossa.
References: 1Clin Neurol Neurosurg. 2013 Jun;115(6):651-7. doi:
10.1016/j.clineuro.2012.07.026. Epub 2012 Aug 17.
Microneurosurgery in combination with endovascular embolisation in the treatment
of solid haemangioblastoma in the dorsal medulla oblongata.
Wu P(1), Liang C, Wang Y, Guo Z, Li B, Qiu B, Li X, Wen Z, Pan Q