Brain Tumor Res Treat.  2014 Oct;2(2):128-131. 10.14791/btrt.2014.2.2.128.

Large Solid Hemangioblastoma in the Cerebellopontine Angle: Complete Resection Using the Transcondylar Fossa Approach

• Moon BH
• Park SK
• Han YM

• KMID: 2134285
• DOI: http://doi.org/10.14791/btrt.2014.2.2.128

Abstract

Hemangioblastomas (HBMs) in the cerebellopontine angle (CPA) have rarely been reported. When they are within the CPA, they may be misdiagnosed as vestibular schwannoma (VS) or cystic meningioma. Therefore, differential diagnosis is important for the safe treatment of the lesion. Large solid HBMs, similar to intracranial arteriovenous malformations (AVMs), are difficult to surgically remove from an eloquent area because of their location and hypervascularity. We report a case of an HBM in the CPA, which manifested as a hearing impairment or VS. Similar to AVM surgery, the tumor was widely opened and removed en bloc without a new neurological complication using the modified transcondylar fossa approach without resection of the jugular tubercle. Accurate diagnosis, pre-operative embolization, and a tailored approach were essential for the safe treatment of the HBM in the CPA.

Keyword

Hemangioblastoma; Cerebellopontine angle

MeSH Terms

Cerebellopontine Angle*
Diagnosis
Diagnosis, Differential
Hearing Loss
Hemangioblastoma*
Intracranial Arteriovenous Malformations
Meningioma
Neuroma, Acoustic

Figure

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  Fig. 1 Pre-operative gadolinium-enhanced magnetic resonance images showing the highly enhanced mass in the cerebellopontine angle with multiple flow voids and peritumoral edema.

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  Fig. 2 Preoperative angiographic imaging showing the angio-arcitecture of the tumor. A: Left vertebral artery angiogram anterior-posterior views of the tumor (large arrow) fed by the superior cerebellar artery (small arrow) and the anterior inferior cerebellar artery (small double arrow). B: After the embolization, angiogram showing a 90% reduction in the tumor vascularity (arrow).

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  Fig. 3 These photographs showing the intraoperative videoimaging (A and C), and intraoperative indocyanine green videoangiography (B). A: Operative photograph after the craniotomy showing the orange tumor. Large arrow: mastoid bone; small black arrows: tumor; and small white arrows: transverse sinus. B: Indocyanine green videoangiography showing the hypervascular tumor (arrow) fed by the anterior inferior cerebellar artery (double arrow). C: Photograph of the coagulated draining vein. Arrow: draining vein.

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  Fig. 4 Gadolinium-enhanced magnetic resonance images obtained a day post-operatively confirming complete resection of the hemangioblastoma.

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  Fig. 5 Photograph of a highly vascular tumor consisting of numerous blood vessels and intervening stromal cells (hematoxylineosin, magnification ×100).

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