Cerebellar Hemangioblastoma Masquerading as Recurrent Posterior Fossa Meningioma: A Case Report

Meningiomas and hemangioblastomas are two entities neurosurgeons may encounter in the posterior fossa. Each lesion has its own unique imaging findings, clinical presentation, and associated risks. Treatment for the two lesions may vary but surgical resection is typically considered definitive for both. While meningioma recurrence is common, hemangioblastoma recurrence is exceedingly rare and hemangioblastoma in the location of previous meningioma even more so, with zero reported cases until now.

A 59-year-old female with a medical history significant only for a self-reported left cerebellar meningioma excision nearly forty years ago presented with posterior headache, dysmetria, and gait imbalance. Brain magnetic resonance imaging (MRI) revealed a T1 hypointense and T2 hyperintense mass in the left cerebellum that appeared to arise from the tentorium. Angiography and preoperative embolization of feeder vessels was performed in what was suspected to be a recurrent meningioma with exuberant vascularity. The patient underwent a paramedian suboccipital craniotomy and the mass was successfully removed. The mass was felt to be an arteriovenous malformation with coexisting aneurysm based on intraoperative findings and review of imaging. The histologic examination was consistent with hemangioblastoma.

We present a case of hemangioblastoma that was discovered intraoperatively after being mistaken for recurrent posterior fossa meningioma in the preoperative assessment period.