Cerebellar Hemispheric Hemangioblastoma
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Let's review techniques for resection of cerebellar hemangioblastoma. This is a 56 year old female who presented with imbalance, and on MRI evaluation was found to have a very cystic tumor with a small enhancing nodule in their right cerebellar hemisphere, characteristic of a hemangioblastoma. Remove the nodule obviously in this case is not challenging, however, reaching the nodule can be a little bit tricky. In this case, instead of going straight through the cerebellum and destroying and transgressing some of the normal cerebellum, I went supracerebellar, entered the thinnest part of their neural tissue over the cyst, and then remove the nodule. So let's go ahead and review the techniques for resection of this mass. Patient was a relatively heavy set, therefore, a hockey stick incision was used to complete a lateral or paramedian supracerebellar craniotomy. The transverse sinuses has to be on roofed. Here you can see the initial burr hole was placed over the lateral transverse sinus the dural was dissected away. And at paramedian, cerebellar craniotomy was elevated removing the bone or the transverse sinus. Since the dural sinus and the dura were both well dissect away from the bone, I elevated the bone flap in one piece and traveled over the sinus while remaining, always flushed close to the inner surface of the calvarium. Here you can see the sinus, the groove within the bone will be evident on the bone flap. Here you can see that. The dural was open at curly fashioned based over the transverse sinus. Retention sutures were placed in the dura to elevate the sinus and provide a super cerebellar trajectory. A ventricular needle was placed within the cyst to drain cyst fluid and decompressed the cerebellum, so the supracerebellar quarter can be reached. Two retention sutures were placed into the posterior aspect of the tentorium to elevate the sinus. I exposed the tentorial surface of the cerebellum, entered the cyst and removed the nodule using standard microsurgical techniques, defeating arterial branches to the nodule or a parent nodule was disconnected from the surrounding white matter. You can see the walls of the cyst. Here, some of the feeding vessels to the nodule. The nodule was circumferential disconnected and delivered. Most of the cerebellum remains intact. You see, I only transgressed the thinnest part of the cerebellum over the cyst to preserve as much of neural tissue as possible. Here's the final overview of the operative corridor. The dural was closed in a watertight fashion. Post operative MRI demonstrated complete removal of the nodule, decompression of the cyst and, preservation of most of the cerebellum over the cyst, again, reaching the cyst through the thinnest portion of the cerebellum was a nice strategy to avoid destruction of their cerebellum over the posterior aspect of the nodule. Thank you.
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