J Cerebrovasc Endovasc Neurosurg.  2014 Sep;16(3):293-298. 10.7461/jcen.2014.16.3.293.

Aneurysm of the Posterior Meningeal Artery Embedded Within a Dorsal Exophytic Medullary Hemangioblastoma: Surgical Management and Review of Literature

• Raygor KP
• Rowland NC
• Cooke DL
• Solomon DA
• Huang MC

• KMID: 1963170
• DOI: http://doi.org/10.7461/jcen.2014.16.3.293

Abstract

Hemangioblastomas are World Health Organization (WHO) Grade I neoplasms of the hindbrain and spinal cord, whose management can be complicated by preoperative hemorrhage. We report on a case of a young female in extremis with posterior fossa hemorrhage following rupture of a fusiform posterior meningeal artery aneurysm embedded within a medullary hemangioblastoma. We discuss management options, including operative staging and embolization, and review similar cases of hemangioblastoma associated with aneurysm.

Keyword

Aneurysm; Hemangioblastoma; Embolization; Posterior fossa hemorrhage

MeSH Terms

Aneurysm*
Female
Hemangioblastoma*
Hemorrhage
Humans
Intracranial Hemorrhages
Meningeal Arteries*
Rhombencephalon
Rupture
Spinal Cord
World Health Organization

Figure

• 

  Fig. 1 Preoperative imaging showing a posterior fossa subarachnoid hemorrhage and a hypervascular mass. (A) Axial non-contrast computed tomography (CT) image showing hemorrhage in the subarachnoid space of the posterior fossa. (B) Axial non-contrast CT scan showing extension of hemorrhage into the third and lateral ventricles. (C) Sagittal contrast-enhanced CT scan showing a hypervascular mass, measuring 1.8 cm, below the cerebellum. (D) Axial T1-weighted magnetic resonance imaging (MRI) with gadolinium enhancement showing a heterogenously enhancing mass associated with the dorsal aspect of the medullary-cervical junction.

• 

  Fig. 2 Digital subtraction angiography. (A) Preoperative angiogram, right vertebral artery (VA) injection, lateral view, demonstrating a prominent vascular tumor and an embedded fusiform posterior meningeal artery aneurysm, which measured 4.5 mm. (B) Pre-operative angiogram, right VA injection, antero-posterior view, showing multiple dissections (white arrows) of the cervical segment of the right VA as well as the aneurysm (black arrow). (C) Post-operative angiogram, right VA injection, lateral view, showing no residual tumor or aneurysm.

• 

  Fig. 3 Histopathology of hemangioblastoma. Hematoxylin and eosin (H&E) stained tissue section from the initial tumor resection, demonstrating a rich capillary network with intervening neoplastic stromal cells with clear foamy cytoplasm diagnostic of hemangioblastoma (400×).

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