Arterial bleeding during surgical removal of the solid cerebellar hemangioblastoma is reported to be difficult to control. Based on our operative experiences with two large and solid cerebellar hemangioblastomas, some useful strategies for such tumor removal will be proposed. Case 1. male 35 yrs.
The operation was performed by the right suboccipital approach with the patient in the left lateral decubitus position. The tumor was located within the right cerebellar hemisphere and had a large draining vein on the surface of the right hemisphere. The right anterior inferior cerebellar artery entered into the ventral portion of the tumor. Therefore, it was not possible to control this feeding artery until the tumor volume was considerably decreased. The tumor was dissected from the surrounding cerebellar parenchyma, and a Sugita's ultra-long clip was applied to the dissected solid portion of the tumor. Furthermore it was ligated with a silk thread so as to completely cut off the blood flow into the tumor. The tumor was resected piecemeal and the tumor volume was significantly reduced. The feeding vessel was finally clipped and the tumor was totally removed. Case 2. female 67 yrs.
The tumor, situated within the cerebellar vermis, protruded into the fourth ventricle and resulted in obstructive hydrocephalus. The operation was approached by the midline suboccipital craniectomy and C1 laminectomy with the patient in a prone position. One of the feeding vessels, posterior inferior cerebellar artery, was clipped temporally. Although an attempt was made to remove the tumor in a destructive manner using CUSA, uncontrollable bleeding was encountered during the procedure. Therefore, the tumor was incised piece by piece using the monopolar electric coagulating loop. Finally, feeding artery and draining vein were clipped together. The tumor occupying the dorsal part of the fourth ventricle was removed en bloc. Conclusion: Various clips for aneurysm and monopolar electric coagulating loop are very useful for the resection of solid cerebellar hemangioblastoma. These techniques are expected to be useful for other hemorrhagic, large, and solid tumors or some AVMs.