Unilateral Occipital Transtentorial Approach with Multimodal Assistance for Resection of Large Supracerebellar Hemangioblastomas: Preliminary Experience of 2 Cases

The surgical resection of large supracerebellar hemangioblastomas (SHBs) is exceptionally challenging due to their vascularity and deep anatomic location and is associated with a high risk of postoperative complications and mortality. Access to the posterior incisural space can be achieved by either...

Full description

Saved in:
Bibliographic Details
Published in:World neurosurgery 2019-09, Vol.129, p.e733-e740
Main Authors: Kawauchi, Daisuke, Higuchi, Yoshinori, Ikegami, Shiro, Adachi, Akihiko, Ozaki, Ko, Suda, Izumi, Kobayashi, Eiichi, Iwadate, Yasuo
Format: Article
Language:English
Subjects:
Aged
Brain Neoplasms - diagnostic imaging
Brain Neoplasms - surgery
Embolization, Therapeutic
Endoscopic procedure
Female
Hemangioblastoma - diagnostic imaging
Hemangioblastoma - surgery
Humans
Magnetic Resonance Imaging
Neuroendoscopy
Neurosurgical Procedures - methods
Occipital transtentorial approach
Preoperative embolization
Supracerebellar hemangioblastoma
Treatment Outcome
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:The surgical resection of large supracerebellar hemangioblastomas (SHBs) is exceptionally challenging due to their vascularity and deep anatomic location and is associated with a high risk of postoperative complications and mortality. Access to the posterior incisural space can be achieved by either an infratentorial supracerebellar approach or occipital transtentorial approach (OTA). However, the optimal surgical strategy has not yet been established. Here, we report 2 cases of large SHBs that were successfully and safely resected via a unilateral OTA with multimodal assistance. Two patients presented to our hospital with ataxia due to large, solid SHBs. After preoperative embolization, gross total resection of the SHBs was achieved via an OTA. Furthermore, endoscopic assistance was used to resect the remnant portion of the tumor in the second patient. Both patients experienced transient ataxia but were discharged from the hospital without serious complications. The combination of an OTA with preoperative embolization and endoscopic assistance may reduce the intraoperative risk and contribute to improved outcome in patients with such clinically challenging tumors.
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2019.06.001