Neurointervention.  2014 Feb;9(1):45-49. 10.5469/neuroint.2014.9.1.45.

Preoperative Embolization of Cerebellar Hemangioblastoma with Onyx: Report of Three Cases

• Shin GW
• Jeong HW
• Seo JH
• Kim ST
• Choo HJ
• Lee SJ

• KMID: 1910774
• DOI: http://doi.org/10.5469/neuroint.2014.9.1.45

Abstract

Hemangioblastoma is a benign and highly vascular tumor. Complete surgical resection of highly vascular tumor such as hemangioblastoma may be challenging due to excessive bleeding. Preoperative embolization of these lesions may decrease the intraoperative blood loss and facilitate excision. We report three cases of cerebellar hemangioblastomas that were embolized using Onyx.

Keyword

Hemangioblastoma; Endovascular procedure; Embolization/therapy; Onyx

MeSH Terms

Endovascular Procedures
Hemangioblastoma*
Hemorrhage

Figure

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  Fig. 1 A. Brain MRI (Contrast-enhanced T1-weighted image) reveals a 2.7 × 2.5 cm sized heterogeneously enhancing tumor with multiple signal void vascular structure within the tumor in the right cerebellar hemisphere. B. Diagnostic angiogram reveals the high vascularity with AV shunting within the tumor, which is characteristic for hemangioblastoma. C. The patient undergoes embolization of two distal pedicles off the right superior cerebellar artery using Onyx, resulting in near complete resolution of the tumor blush. D. Native cranial view in posteroanterior projection demonstrates a dense Onyx cast within mural nodule of the tumor. E. Histological examination of the excised tumor shows that the hemangioblastoma is composed of stromal cells, which show characteristically large and vacuolated appearance, and abundant vascular cells, such as endothelial cells and pericytes. Nidus vessels are occluded with thrombus and black colored embolic material, Onyx.

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  Fig. 2 A. Brain MRI (Contrast-enhanced T1-weighted image) reveals a cystic tumor with a densely enhancing mural nodule in the right cerebellum. B. A diagnostic vertebral angiogram reveals early intense tumor staining (arrows) in the right cerebellum from the right superior cerebellar artery. C. The patient undergoes embolization of core feeder vessel originated off the right superior cerebellar artery using Onyx. Final angiogram shows near complete resolution of the tumor blush.

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  Fig. 3 A. Brain MRI (Contrast-enhanced T1-weighted image) reveals a large cystic tumor with a heterogeneously enhancing mural nodule in the right cerebellum with tumor effect causing displacement of the fourth ventricle. B. A diagnostic vertebral angiogram reveals early intense tumor staining in the right cerebellum from the right superior cerebellar artery. C. The patient undergoes embolization of core feeder vessel originated off the right superior cerebellar artery using Onyx. Final angiogram shows near complete resolution of the tumor blush.

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