PMC4855793_01
(a) Axial CT without contrast demonstrating cystic midline posterior fossa lesion with mild obstructive hydrocephalus. Axial (b), sagittal (c), and coronal (d) volumetric T1 with gadolinium MRI demonstrating enhancing lesion at the tentorial apex adjacent to the vein of galen with large cystic component with the cerebellum.
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A contrast enhanced Computerized Tomography (CT) scan of the head demonstrated a midline posterior fossa cystic lesion with surrounding vasogenic edema resulting in effacement of the fourth ventricle and obstructive hydrocephalus (Fig. 1a). Magnetic resonance imaging (MRI) confirmed a cystic lesion with a solid enhancing 1.6 x 1.4 x 1.1 cm component in the superior aspect of the vermis near the tentorial edge (Fig. 1b-d).
Postoperative sagittal volumetric T1 with gadolinium demonstrating gross total resection after supracerebellar infratentorial approach.
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Post-operative MRI demonstrated gross total resection (Fig. 2).
Sagittal (left) and axial (right) volumetric T1 with gadolinium at six month follow-up demonstrating no tumor recurrence, but some subtle increased vascularity at the posterior tentorium along the left vermis.
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Repeat MRI revealed no recurrence of the lesion (Fig. 3).
(a) Axial CT without contrast demonstrating left tentorial acute subdural hematoma and intraparenchymal hemorrhage with the left cerebellar hemisphere. (b) Axial thin-slice CT angiogram (CTA) and axial (c) and sagittal (d) volumetric T1 with gadolinium demonstrating subtle increased vascularity along posterior tentorium along the left vermis.
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CT scan of her head demonstrated an acute left tentorial subdural hematoma as well as a small left cerebellar intracranial hemorrhage (Fig. 4a). Further CT angiography and MRI demonstrated a nodular focus of enhancement on the medial margin of the left cerebellar hemorrhage raising concern for new or recurrent haemangioblastoma (Fig. 4b-d).
AP (a) and Lateral (b) digital subtraction angiography with left vertebral artery injection demonstrating a 2.4 x 0.9 x 1.0 cm left paramedian posterior tentorial arteriovenous malformation being fed by bilateral posterior inferior cerebellar arteries and the left superior cerebellar artery. Venous drainage is through the torcula into the right transverse sinus. AP (c) and Lateral (d) digital subtraction angiography demonstrating small 2.5 x 2.0 mm intranidal aneurysm (white arrow).
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Diagnostic digital subtraction angiogram (DSA) was then performed and demonstrated a 2.4 x 0.9 x 1.0 cm left posterior tentorial paramedian cerebellar vascular nidus primarily supplied by bilateral posterior inferior cerebellar arteries and left superior cerebellar artery with venous drainage into the left transverses sinus suspicious for arteriovenous malformation (Fig. 5a, b). In addition, there was a 2.5 x 2.0 mm intranidal aneurysm (Fig. 5c, d).