case_images: PMC11090543_01
case_images: (a) Lateral incidence of angiography of the left external carotid artery, where a tumor blush is observed (thin arrow), which is irrigated through the occipital artery (empty arrow), the posterior meningeal artery (thick arrow) and the parietal branch of the left middle meningeal artery (arrowhead). (b) Anteroposterior (AP) incidence of angiography of the left vertebral artery, where it is observed the tumor blush (thin arrow), which is irrigated through the left posterior inferior cerebellar artery (thick arrow) and the left anterior inferior cerebellar artery (empty arrow). (c) Brain magnetic resonance imaging (MRI) non-enhanced T1 sequence, where a heterogeneous mass is evident, hypointense, with cystic portions in his medial part (arrow). (d) Brain MRI contrast-enhanced T1, where it is observed that the solid parts enhance (arrow), and the measurements are 5.8 x 8.5 cm (AP x T). (e) Brain MRI T2 sequence in coronal view shows a heterogeneous left cerebellar mass (thick arrow), with cystic portions and other solid, slightly hyperintense portions (thin arrow). (f and g) Immediate postoperative brain computed tomography non-enhanced in axial view (f) and coronal view (g) that shows gross total resection of the tumor that is replaced by pneumocephalus (thick arrow), it also demonstrates embolizing material in the more lateral part of the surgical area (thin arrow).
case_images: SNI-15-144-g001.jpg
case_images: PMC11090543_01_SNI-15-144-g001.jpg
case_images: F1
case_images: Contrast-enhanced brain magnetic resonance imaging (MRI) showed a heterogeneous tumor, with the main solid component that avidly enhances, in the left cerebellar region, 5.8 x 8.5 x 6.9 cm (AP x T x CC), which severely compresses the IV ventricle, contact the brainstem, with moderate perilesional edema [Figure 1]. In addition, through the vertebrobasilar system, it was seen that the tumor is irrigated by the left posterior inferior cerebellar artery (PICA) and anterior inferior cerebellar artery (AICA) [Figure 1]. Postoperative brain tomography showed apparent gross total resection, with afferent vessels embolized in the lateral edge of the surgical field in the cerebellopontine angle cistern, with little pneumocephalus, without hematoma and other complications [Figure 1].
case_images: PMC11090543_02
case_images: (a) Angiography of the right external carotid artery in lateral incidence where tumor blush is evident (thin arrow) with afference through the right occipital artery (thick arrow) and the parietal branch of the right middle meningeal artery (empty arrow). (b) Left vertebral artery angiography in anteroposterior incidence where right cerebellar tumor blush is evident (thin arrow), with afference through the right superior cerebellar artery (thick arrow). (c) Intraoperative imaging during preoperative embolization, where it is observed the filling of the tumor with embolizing material (arrow). (d) Brain angiotomography in axial view shows a right cerebellar mass (arrow) that avidly enhances; it is evident that it is hypervascularized. (e and f) Contrast-enhanced brain magnetic resonance imaging T1 sequence in axial section (e) and sagittal section (f) showing recurrence of solid hemangioblastoma (arrow) in the right cerebellar hemisphere in its most lateral part. (g and h) Small nucleus cells, broad vacuolated cytoplasm, abundant vascularization with flattened endothelium and intratumoral hemorrhage areas, x4 view (g) and x10 view (h).
case_images: SNI-15-144-g002.jpg
case_images: PMC11090543_02_SNI-15-144-g002.jpg
case_images: F2
case_images: In addition, a brain angiotomography was performed, showing multiple tumor afferents [Figure 2]. Through the vertebrobasilar system, the afferent was mainly by the right superior cerebellar artery and, in less volume, by a filiform branch of the right PICA [Figure 2]. The pathological anatomy confirmed the diagnosis of the WHO grade I hemangioblastoma [Figure 2]. A contrast-enhanced brain MRI was performed 1 year after surgery, which showed a tumor recurrence of <3 Cm in the right cerebellum, compatible with a solid hemangioblastoma [Figure 2].