The Impact of Preoperative Endovascular Embolization on Surgical Outcome of Cerebellar Cystic Hemangioblastoma

Background: Cystic hemangioblastoma (HB) account for 1.5-2.5% of all intracranial and 7-12% of posterior fossa tumors. The treatment of choice is total resection though their hypervascularity and location present a formidable challenge. Preoperative embolization may have a role in these cases. Objective: We present a single center experience with twelve cases of intracranial cystic hemangioblastomas. Six retrospective cases and another six cases in a prospective study design of preoperative embolization. The study presents a preliminary experience with poly –vinyl alcohol copolymer for hemangioblastoma vessel embolization before surgical resection. Patients and Methods: This study included all patients of intracranial hemangioblastoma admitted in our department over a period of 5 years, from January 2010 through January 2015. Results: There were a total of twelve patients (nine males and three females). Six cases received preoperative artery embolization. The other six cases underwent surgical resection without preoperative embolization. The main presentation was headache and blurring of vision in most cases. Particles embolization was done in six patients without any post-embolization or post surgical bleeding. Complete obliteration of tumor blush at the control angiogram was achieved in five out of six patients while near total obliteration was achieved in one patient. In the embolized group, complete resection was achieved in all the patients. All the six patients were free of serious complication after the surgery. There were no postoperative hemorrhage, neither permanent morbidity nor mortality in this group. In the control group, complete resection was achieved in five patients. Near total resection of the tumor was achieved in one patient that had ataxia at hospital discharge and improved on follow up with equally no mortality in this group. Conclusion: Preoperative embolization of cystic HB provides a safe, short and clear surgery for the neurosurgeons and faster rehabilitation for the patients.