Cerebellar Hemangioblastoma: Fluorescence

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This video describes resection of cerebellar hemangioblastomas, more specifically, the lateral hemispheric ones, And also reviews the importance of intraoperative fluorescence techniques. This is a 31 year old male who presented with cerebellar symptoms and ataxia, including dysmetria and MRI evaluation demonstrated a relatively homogeneously enhancing mass with partial cystic areas with evidence of edema. He subsequently underwent a right-sided lateral suboccipital or retro mastoid craniotomy. You can see the exposure of the mass along the lateral and inferior part of the cerebellum. You can see the nitus of the mass that is very much enhancing with flouricine fluorescence. Here are the arterial branches to the hemangioblastoma or the malformation. And here are they draining veins leaving the nitus. The borders of the nitus are relatively clear. I started my dissection around the circumference of the hemangioblastoma while preserving the draining veins and disconnecting their arterial feeders. The tumoral area is quite evident from the nitus of the hemangioblastoma. Some of the areas of the hemangioblastoma appear to be more bloody than the other ones during the resection. We continue to disconnect the nitus of the hemangioblastoma circumferentially in the white matter, staying right on the gliotic surfaces of the cerebellum and the pretumoral areas. Some of the white matter feeding vessels are being quite coagulated and cut. Here you can see the border of the nitus versus the pretumoral areas. Some of the feeding vessels through the peel membranes more inferiorally or being coagulated and cut. We continue dissection. You can see again, the white matter and nucleotic surface around the nitus. Here is disconnection of a nitus more anteriorly from the surrounding white matter. Here's the nitus that was subsequently delivered. Further inspection using fluorescence revealed potentially some residual nitus. This part of the hemangioblastoma was also subsequently dissected and removed. Therefore, flouricine fluorescence appear to be quite useful. Here are the lower cranial nerves. And the postoperative MRI confirmed course total remove the mass without any complicating features. Thank you.

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