title: Attenuation of vascularity by preoperative radiosurgery facilitates total removal of a hypervascular hemangioblastoma at the cerebello-pontine angle: case report.
abstract: BACKGROUND
  The surgical removal of solid, large, and deep-seated hemangioblastomas remains challenging because it is difficult to control bleeding during the procedure. We used preoperative radiosurgery in a solid, highly vascular hemangioblastoma at the left cerebello-pontine angle and present our angiographic, operative, and histologic findings.
  
  
  METHODS
  A 37-year-old paraplegic woman with multiple hemangioblastomas was re-admitted to our clinic with cerebellar ataxia 6 years after resection of a tumor at the fourth ventricle. A vertebral artery angiogram revealed that the 3.5 cm diameter hemangioblastoma at the left cerebello-pontine angle was highly vascular and fed by the left anterior inferior cerebellar artery and posterior inferior cerebellar artery. Nine months before surgical removal it was treated with stereotactic radiosurgery (gamma knife, margin dose 28 Gy) to inhibit tumor progression and to reduce its vascularity. The tumor was totally removed via the left lateral suboccipital approach; bleeding was well controlled and there were no complications. Pathologic examination of the content of the excised tumor revealed coagulation necrosis with hyaline degeneration of the tumor vessels, resulting in a marked decrease in its vascularity.
  
  
  CONCLUSIONS
  Preoperative radiosurgery led to a marked reduction in the vascularity of this hypervascular hemangioblastoma and was useful for controlling bleeding from the tumor during resection. We succeeded to remove the vascular-rich hemangioblastma after the intentional preoperative radiosurgery. The pathologic changes induced by radiotherapy were confirmed by operative finding.
authors.affiliation: Department of Neurosurgery, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kamitani
authors.forename: Nobuo
authors.initials: N
authors.lastname: Hirano
authors.forename: Haruo
authors.initials: H
authors.lastname: Takigawa
authors.forename: Masayuki
authors.initials: M
authors.lastname: Yokota
authors.forename: Hajime
authors.initials: H
authors.lastname: Miyata
authors.forename: Eisaku
authors.initials: E
authors.lastname: Ohama
authors.forename: Takashi
authors.initials: T
authors.lastname: Watanabe
mesh_terms: D000328:Adult; D002528:Cerebellar Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002530:Cerebellopontine Angle / Q000098:blood supply* / Q000601:surgery*; D005260:Female; D018325:Hemangioblastoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011859:Radiography; D016634:Radiosurgery / Q000379:methods*