Endovascular embolization and surgical excision for the treatment of cerebellar and brain stem hemangioblastomas

Hemangioblastomas are histologically benign tumors that comprise 7%-10% of all posterior fossa lesions in the adult. Treatment of these lesions is often complicated by significant vascularity and difficulty of surgical resection in sensitive neural tissue, especially when the tumor has a significant solid component. We report the combined use of endovascular embolization of feeding pedicles and subsequent operative resection in two patients with solid hemangioblastomas of the cerebellum and brain stem. Preoperative embolization facilitated operative excision in sensitive neural areas and allowed complete surgical resection of tumors involving the lateral brain stem and cervicomedullary junction. Goals of preoperative embolization are control of inaccessible arterial supply and reduction of tumor vascularity.