title: The value of preoperative embolization in large and giant solid cerebellar hemangioblastomas.
abstract: BACKGROUND
  Solid cerebellar hemangioblastomas are highly vascular lesions and may cause catastrophic hemorrhage during excision.
  
  
  METHODS
  This retrospective study enrolled 10 patients (7 men and 3 women, with a mean age of 38.2 ± 12.5 years) with solid cerebellar hemangioblastomas. All patients had a solitary tumor and underwent surgical resection of the lesion through a suboccipital approach. The basic features, serial radiographic examinations, and operative records were analyzed.
  
  
  RESULTS
  The most common presenting symptoms were headache (100%), ataxia (100%), and long tract manifestations (60%). Three patients had experienced failed surgery previously due to massive intraoperative bleeding. Three patients were confirmed as having Von Hippel-Lindau disease. The average size of the tumor was 40.7 ± 8.7 mm in its maximal diameter (range 25-58 mm). Total endovascular occlusion obtained in six patients, near total occlusion in three patients, and incomplete occlusion in one patient. Nine (90.0%) patients underwent gross total resection and one (10.0%) underwent partial resection. After the primary surgery, eight (80.0%) patients experienced improvement in their symptoms, two (20.0%) maintained their pre-treatment status, and none showed neurological deterioration following tumor resection. Blood loss during surgery after embolization was minimal and controllable.
  
  
  CONCLUSIONS
  Preoperative embolization improves safety and efficacy of the microsurgical excision of such tightly located very vascular tumors. Embolization changes the concept of this lesion surgery into piecemeal removal rather than a total mass extraction technique. Liquid agents are superior to particles in obliteration of such lesions.
authors.affiliation: Department of Neurosurgery, Alexandria University School of Medicine, Egypt The Research Center of Computational Neurovascular Biomechanics, Somoha University Hospital, Alexandria, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Sultan
authors.affiliation: Department of Neurosurgery, Alexandria University School of Medicine, Egypt The Research Center of Computational Neurovascular Biomechanics, Somoha University Hospital, Alexandria, Egypt Tamer.shihata@alexmed.edu.eg.
authors.forename: Tamer
authors.initials: T
authors.lastname: Hassan
authors.affiliation: Department of Neurosurgery, Alexandria University School of Medicine, Egypt.
authors.forename: Hisham
authors.initials: H
authors.lastname: Aboul-Enein
authors.affiliation: The Research Center of Computational Neurovascular Biomechanics, Somoha University Hospital, Alexandria, Egypt Department of Interventional Neurology, Alexandria University School of Medicine, Egypt.
authors.forename: Osama
authors.initials: O
authors.lastname: Mansour
authors.affiliation: Department of Neurosurgery, Alexandria University School of Medicine, Egypt The Research Center of Computational Neurovascular Biomechanics, Somoha University Hospital, Alexandria, Egypt.
authors.forename: Tamer
authors.initials: T
authors.lastname: Ibrahim
mesh_terms: D000293:Adolescent; D000328:Adult; D002528:Cerebellar Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D018325:Hemangioblastoma / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Solid cerebellar hemangioblastoma; embolization