PMC5629862_01
Preoperative brain MRI sequences. (a) T2-weighted axial; (b) T1-weighted axial without contrast; (c) T1-weighted axial with contrast; (d) T1-weighted coronal with contrast. Images show a bilobular well-defined homogeneous solid mass (arrows) with a medial cystic component (arrowheads) involving the inferior and medial aspects of the right cerebellar hemisphere, consistent with recurrent disease. Adjacent postsurgical changes (asterisks) are also observed
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F1
Brain magnetic resonance imaging (MRI) upon admittance revealed two brightly enhancing nodules with a medial cyst in the inferior surface of the right cerebellar hemisphere, which was consistent with recurrent disease [Figure 1].
Diagnostic and postembolization angiograms. (a and b) AP and lateral views show a bilobular hypervascular mass with delineation of the cystic medial hypovascular component. The lateral main branch (arrowhead) of the right AICA-PICA complex (arrow) supplies the mass, as described in the text. (c and d) AP and lateral views show evidence of obliteration of approximately 70% of the lesion with a minimal residual filling of its medial component. The Onyx cast is visualized (circle)
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F2
A right vertebral diagnostic angiography showed a right AICA-PICA complex as the main feeder of the tumor [Figure 2].
Intraoperative findings and microphotographs of hematoxylin-eosin-stained slides of the specimen. (a) The devascularized tumor (arrows) is held by a spatula, exposing a vessel containing embolization material (arrowheads). Normal cerebellar parenchyma can be observed on the inferior left corner of the picture. (b) The abundance of monomorphic stromal cells with pale and vacuolated cytoplasm is consistent with a recurrent hemangioblastoma (40x). (c) Onyx (arrows) can be observed within a vascular lumen, along with surrounding ischemic-induced pathological changes (10x)
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F3
Pathology demonstrated a recurrent hemangioblastoma with embolization-induced ischemic changes [Figure 3].
Postoperative brain MRI sequences (13 days later). (a) T2-weighted FLAIR axial; (b) T1-weighted axial without contrast; (c) T1-weighted axial with contrast; (d) T1-weighted coronal with contrast. Images show a small hematoma (arrow) in the medial aspect of the surgical cavity, mild residual edema (asterisk) and minimal linear postsurgical enhancement (arrowhead) without evidence of a residual lesion
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