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Let's review the details for a section of a simple hemispheric cerebellar hemangioblastoma. This is the case of a 71 year old male who presented with gait dysfunction and imbalance. MRI evaluation revealed a large cystic mass within the right cerebellar hemisphere predominantly associated with the enhancing nodule. This is suspected to be Hemangioblastoma. He underwent, a right-sided paramedian suboccipital craniotomy. I can see the exposure of the dura to transverse sinuses located just above the level of the dural exposure. Dural was open in a cruciate fashion. Here's the right cerebellum. Small corticotomy was created just over the surface of the cyst. Can see a significant amount of brain relaxation achieved upon drainage of the cyst fluid only very small corticotomy is necessary. Next under high magnification, the nodule is readily apparent. I go ahead and inspect the nodule to delineate the borders of the nodule. The bipolar forceps are used next to disconnect the nodule from the surrounding cerebellum. Very simple procedure. This lesion can be quite hypervascular. However the bleeding can readily be controlled using the bipolar forceps. The feeding vessels are also coagulated as you can see here and sharply cut. The most important principle is to achieve a gross totalling all the mass, and do not leave any part of the nodule behind to minimize the risk of future cyst recurrence. Now that the lateral posterior and the medial border of the nodule is dissected I'll go ahead and disconnect the anterior border of the nodule. I may actually expose the tentorium during this maneuver. Here you can see the tentorial surface of the cerebellum. The tentorium would be located just above this opening. You can see the white glistening surface of the cerebellum again indicating clean the resection of the mass. The appropriate borders are exposed. Small feeding vessels from the tentorial surface of the cerebellum are being disconnected so that nodule can be delivered. This is the tentorium. No residual masses apparent. I'm satisfied with the extent of resection and a post operative MRI confirms this extent of resection without any complicating features. Thank you.
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