PMC4199150_01
(a) Gadolinium-enhanced magnetic resonance imaging (MRI) revealed an enhanced mass in the cerebellar vermis. (b) Brain CT image revealed massive SAH in the posterior fossa after rebleeding
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Gadolinium-enhanced magnetic resonance imaging (MRI) revealed an enhanced mass in the cerebellar vermis [Figure 1a]. Brain computed tomography (CT) showed subarachnoid hemorrhage (SAH) in the posterior fossa [Figure 1b].
Preoperative left vertebral angiogram note the tumor stain. The tumor is fed by the vermian branch of the left posterior inferior cerebellar artery. A flow-related aneurysm (arrow) is seen in the arterial phase
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A left vertebral angiogram showed a tumor stain in the cerebellar vermis fed by the posterior inferior cerebellar artery (PICA) and an aneurysm on the distal portion of the feeder [Figure 2].
Left vertebral angiograms. (a)Intraoperative view before embolization (b) Superselective angiograms from the microcatheter show a dumbbell-shaped aneurysm just distal to the catheter tip. (c) NBCA injection into the aneurysm and the distal and proximal part of the feeder. (d) Complete disappearance of the aneurysm and the anterior part of the tumor stain seen in Figure 2
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PICA just proximal to the aneurysm, we carefully injected a 20% NBCA-lipiodol mixture into the aneurysm and the distal portion of the main feeder. Postoperative left vertebral angiograms confirmed the complete disappearance of the aneurysm; the anterior part of the tumor stain was clearly diminished [Figure 3a-d].
(a) Intraoperative findings. Note the ruptured aneurysm (arrow) on the feeder near the vascular-rich tumor (asterisk). (b) Microphotograph of the aneurysm showing disruption of the internal elastic lamina and rupture of the adventitia (Elastica van Giesson staining, original magnification x10)
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PICA aneurysm [Figure 4a]. Pathological findings confirmed our preoperative diagnosis of cerebellar hemangioblastoma and intracerebral aneurysm, and showed disruption of the internal elastic lamina and rupture of the adventitia [Figure 4b].