{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T16:41:32Z","timestamp":1784997692545,"version":"3.55.0"},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"21","license":[{"start":{"date-parts":[[2024,5,20]],"date-time":"2024-05-20T00:00:00Z","timestamp":1716163200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,20]]},"abstract":"\n BACKGROUND<\/jats:title>\n Resection remains the optimal treatment for hemangioblastomas, highly vascular tumors commonly located in the cerebellum or spinal cord. Preoperative embolization can be used with caution to reduce intraoperative blood loss and promote gross-total resection while reducing neurological morbidity.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n The authors report a case of a 44-year-old male who presented with worsening dizziness, gait imbalance, and diplopia. Imaging revealed a large vascular cerebellar mass with brainstem compression and hydrocephalus, concerning for hemangioblastoma. The patient underwent preoperative embolization of the main arterial supply from the right superior cerebellar artery, which devascularized the tumor and reduced the early venous shunting, followed by gross-total resection of the tumor. Preoperative embolization helped to facilitate safe microsurgical resection because this main arterial supply was deep to the planned surgical approach, and the Onyx cast served as a landmark of the dorsal midbrain and remaining arterial supply. This resulted in minimal intraoperative blood loss. At 2-year follow-up, the patient\u2019s diplopia and vertigo had resolved, and his gait continues to improve.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n Despite controversy regarding the use of preoperative embolization for hemangioblastoma resection, the authors emphasize its safety and utility during resection of a large cerebellar hemangioblastoma. Onyx embolization provided benefit in both reducing the tumor blood supply and serving as intraoperative visual guidance.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case24100","type":"journal-article","created":{"date-parts":[[2024,5,20]],"date-time":"2024-05-20T02:42:24Z","timestamp":1716172944000},"source":"Crossref","is-referenced-by-count":3,"title":["Preoperative embolization and microsurgical resection of a cerebellar hemangioblastoma: embolization goals and technical nuances of the approaches. Illustrative case"],"prefix":"10.3171","volume":"7","author":[{"given":"Hope M","family":"Reecher","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Hussain","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randall","family":"Treffy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John D","family":"Nerva","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Clin Neurol Neurosurg.","first-page":"143","article-title":"Safety and outcomes of preoperative embolization of intracranial hemangioblastomas: a systematic review","volume":"150","author":"Ampie L","year":"2016","unstructured":"Ampie L, Choy W, Lamano JB, et\u00a0al. Safety and outcomes of preoperative embolization of intracranial hemangioblastomas: a systematic review. Clin Neurol Neurosurg. 2016;150:143\u2013151."},{"issue":"10","key":"b2","series-title":"Childs Nerv Syst.","first-page":"2537","article-title":"Hemangioblastoma and von Hippel-Lindau disease: genetic background, spectrum of disease, and neurosurgical treatment","volume":"36","author":"Klingler JH","year":"2020","unstructured":"Klingler JH, Gl\u00e4sker S, Bausch B, et\u00a0al. Hemangioblastoma and von Hippel-Lindau disease: genetic background, spectrum of disease, and neurosurgical treatment. Childs Nerv Syst. 2020; 36(10):2537\u20132552."},{"key":"b3","series-title":"Interdiscip Neurosurg.","first-page":"101232","article-title":"Staged surgical treatment of a hypervascular cerebellar hemangioblastoma and saccular superior cerebellar artery aneurysm using preoperative embolization with a low viscosity non-adhesive liquid embolic agent","volume":"25","author":"Sirko A","year":"2021","unstructured":"Sirko A, Halkin M, Cherednychenko Y, Perepelytsia V\n Staged surgical treatment of a hypervascular cerebellar hemangioblastoma and saccular superior cerebellar artery aneurysm using preoperative embolization with a low viscosity non-adhesive liquid embolic agent. Interdiscip Neurosurg. 2021;25:101232."},{"issue":"2","key":"b4","series-title":"Acta Radiol Open.","first-page":"20584601221077074","article-title":"Advanced magnetic resonance imaging findings of cerebellar hemangioblastomas: a report of three cases and a literature review","volume":"11","author":"Matsusue E IC","year":"2022","unstructured":"Matsusue E IC, Tabuchi S, Yoshioka H, et\u00a0al. Advanced magnetic resonance imaging findings of cerebellar hemangioblastomas: a report of three cases and a literature review. Acta Radiol Open. 2022;11(2):20584601221077074."},{"issue":"4","key":"b5","series-title":"Interv Neuroradiol.","first-page":"482","article-title":"The value of preoperative embolization in large and giant solid cerebellar hemangioblastomas","volume":"22","author":"Sultan A","year":"2016","unstructured":"Sultan A, Hassan T, Aboul-Enein H, Mansour O, Ibrahim T The value of preoperative embolization in large and giant solid cerebellar hemangioblastomas. Interv Neuroradiol. 2016;22(4): 482\u2013488."},{"issue":"7","key":"b6","series-title":"J Clin Neurosci.","first-page":"939","article-title":"A 10-year retrospective study of hemangioblastomas of the central nervous system with reference to von Hippel-Lindau (VHL) disease","volume":"18","author":"Padhi S","year":"2011","unstructured":"Padhi S, Sarangi R, Challa S, Bussary P, Panigrahi MK, Purohit AK A 10-year retrospective study of hemangioblastomas of the central nervous system with reference to von Hippel-Lindau (VHL) disease. J Clin Neurosci. 2011;18(7):939\u2013944."},{"issue":"5","key":"b7","series-title":"J Neurosurg.","first-page":"1055","article-title":"Prospective natural history study of central nervous system hemangioblastomas in von Hippel-Lindau disease","volume":"120","author":"Lonser RR","year":"2014","unstructured":"Lonser RR, Butman JA, Huntoon K, et\u00a0al. Prospective natural history study of central nervous system hemangioblastomas in von Hippel-Lindau disease. J Neurosurg. 2014;120(5):1055\u20131062."},{"issue":"1","key":"b8","series-title":"Neurosurgery.","first-page":"71","article-title":"Risk of hemorrhage in hemangioblastomas of the central nervous system","volume":"57","author":"Gl\u00e4sker S","year":"2005","unstructured":"Gl\u00e4sker S, Van Velthoven V Risk of hemorrhage in hemangioblastomas of the central nervous system. Neurosurgery. 2005;57(1): 71\u201376."},{"issue":"9","key":"b9","series-title":"Neuroradiology.","first-page":"981","article-title":"Preoperative liquid embolization of cerebeller hemangioblastomas using N-butyl cyanoacrylate","volume":"54","author":"Murai Y","year":"2012","unstructured":"Murai Y, Kominami S, Yoshida Y, et\u00a0al. Preoperative liquid embolization of cerebeller hemangioblastomas using N-butyl cyanoacrylate. Neuroradiology. 2012;54(9):981\u2013988."},{"issue":"4","key":"b10","series-title":"J Neurointerv Surg.","first-page":"386","article-title":"N-butyl 2-cyanoacrylate (n-BCA) embolization of a cerebellar hemangioblastoma","volume":"3","author":"Munyon C","year":"2011","unstructured":"Munyon C, Chowdhry SA, Cohen ML, Bambakidis NC, Hsu DP N-butyl 2-cyanoacrylate (n-BCA) embolization of a cerebellar hemangioblastoma. J Neurointerv Surg. 2011;3(4):386\u2013389."},{"issue":"2","key":"b11","series-title":"Oper Neurosurg (Hagerstown).","first-page":"135","article-title":"Safety and efficacy of preoperative embolization of intracranial hemangioblastomas","volume":"12","author":"Ene CI","year":"2016","unstructured":"Ene CI, Xu D, Morton RP, et\u00a0al. Safety and efficacy of preoperative embolization of intracranial hemangioblastomas. Oper Neurosurg (Hagerstown). 2016;12(2):135\u2013140."},{"issue":"6","key":"b12","series-title":"J Neurosurg.","first-page":"1492","article-title":"Neurological morbidity and mortality associated with the endovascular treatment of cerebral arteriovenous malformations before and during the Onyx era","volume":"122","author":"Crowley RW","year":"2015","unstructured":"Crowley RW, Ducruet AF, Kalani MY, Kim LJ, Albuquerque FC, McDougall CG Neurological morbidity and mortality associated with the endovascular treatment of cerebral arteriovenous malformations before and during the Onyx era. J Neurosurg. 2015;122(6): 1492\u20131497."},{"key":"b13","series-title":"Stroke.","article-title":"Middle meningeal artery embolization for chronic subdural hematoma: a review of established and emerging embolic agents","author":"Tudor T","year":"2023","unstructured":"Tudor T, Capone S, Vivanco\u2010Suarez J, et\u00a0al. Middle meningeal artery embolization for chronic subdural hematoma: a review of established and emerging embolic agents. Stroke. 2023: e000906."},{"issue":"3","key":"b14","series-title":"Oncol Lett.","first-page":"1125","article-title":"Surgical treatment of solid hemangioblastomas of the posterior fossa: a report of 28 cases","volume":"13","author":"Cui H","year":"2017","unstructured":"Cui H, Zou J, Bao YH, Wang MS, Wang Y Surgical treatment of solid hemangioblastomas of the posterior fossa: a report of 28 cases. Oncol Lett. 2017;13(3):1125\u20131130."},{"issue":"1","key":"b15","series-title":"Neurointervention.","first-page":"45","article-title":"Preoperative embolization of cerebellar hemangioblastoma with onyx: report of three cases","volume":"9","author":"Shin GW","year":"2014","unstructured":"Shin GW, Jeong HW, Seo JH, Kim ST, Choo HJ, Lee SJ Preoperative embolization of cerebellar hemangioblastoma with onyx: report of three cases. Neurointervention. 2014;9(1): 45\u201349."},{"issue":"2","key":"b16","series-title":"Neurosurg Focus Video.","first-page":"V15","article-title":"Hybrid endovascular and microsurgical treatment for a large mesencephalic-cerebellar hemangioblastoma","volume":"1","author":"Song J","year":"2019","unstructured":"Song J, Li P, Tian Y, Zhao X, Wang X, Zhu W Hybrid endovascular and microsurgical treatment for a large mesencephalic-cerebellar hemangioblastoma. Neurosurg Focus Video. 2019;1(2):V15."},{"key":"b17","series-title":"Interv Neuroradiol.","first-page":"157","article-title":"Complications and their management during NBCA embolization of craniospinal lesions","volume":"9","author":"Niimi Y","year":"2003","unstructured":"Niimi Y, Berenstein A, Setton A Complications and their management during NBCA embolization of craniospinal lesions. Interv Neuroradiol. 2003;9(suppl 1):157\u2013164."},{"key":"b1","series-title":"Clin Neurol Neurosurg.","first-page":"143","article-title":"Safety and outcomes of preoperative embolization of intracranial hemangioblastomas: a systematic review","volume":"150","author":"Ampie L","year":"2016","unstructured":"Ampie L, Choy W, Lamano JB, et\u00a0al. Safety and outcomes of preoperative embolization of intracranial hemangioblastomas: a systematic review. Clin Neurol Neurosurg. 2016;150:143\u2013151."},{"issue":"10","key":"b2","series-title":"Childs Nerv Syst.","first-page":"2537","article-title":"Hemangioblastoma and von Hippel-Lindau disease: genetic background, spectrum of disease, and neurosurgical treatment","volume":"36","author":"Klingler JH","year":"2020","unstructured":"Klingler JH, Gl\u00e4sker S, Bausch B, et\u00a0al. Hemangioblastoma and von Hippel-Lindau disease: genetic background, spectrum of disease, and neurosurgical treatment. Childs Nerv Syst. 2020; 36(10):2537\u20132552."},{"key":"b3","series-title":"Interdiscip Neurosurg.","first-page":"101232","article-title":"Staged surgical treatment of a hypervascular cerebellar hemangioblastoma and saccular superior cerebellar artery aneurysm using preoperative embolization with a low viscosity non-adhesive liquid embolic agent","volume":"25","author":"Sirko A","year":"2021","unstructured":"Sirko A, Halkin M, Cherednychenko Y, Perepelytsia V\n Staged surgical treatment of a hypervascular cerebellar hemangioblastoma and saccular superior cerebellar artery aneurysm using preoperative embolization with a low viscosity non-adhesive liquid embolic agent. Interdiscip Neurosurg. 2021;25:101232."},{"issue":"2","key":"b4","series-title":"Acta Radiol Open.","first-page":"20584601221077074","article-title":"Advanced magnetic resonance imaging findings of cerebellar hemangioblastomas: a report of three cases and a literature review","volume":"11","author":"Matsusue E IC","year":"2022","unstructured":"Matsusue E IC, Tabuchi S, Yoshioka H, et\u00a0al. Advanced magnetic resonance imaging findings of cerebellar hemangioblastomas: a report of three cases and a literature review. Acta Radiol Open. 2022;11(2):20584601221077074."},{"issue":"4","key":"b5","series-title":"Interv Neuroradiol.","first-page":"482","article-title":"The value of preoperative embolization in large and giant solid cerebellar hemangioblastomas","volume":"22","author":"Sultan A","year":"2016","unstructured":"Sultan A, Hassan T, Aboul-Enein H, Mansour O, Ibrahim T The value of preoperative embolization in large and giant solid cerebellar hemangioblastomas. Interv Neuroradiol. 2016;22(4): 482\u2013488."},{"issue":"7","key":"b6","series-title":"J Clin Neurosci.","first-page":"939","article-title":"A 10-year retrospective study of hemangioblastomas of the central nervous system with reference to von Hippel-Lindau (VHL) disease","volume":"18","author":"Padhi S","year":"2011","unstructured":"Padhi S, Sarangi R, Challa S, Bussary P, Panigrahi MK, Purohit AK A 10-year retrospective study of hemangioblastomas of the central nervous system with reference to von Hippel-Lindau (VHL) disease. J Clin Neurosci. 2011;18(7):939\u2013944."},{"issue":"5","key":"b7","series-title":"J Neurosurg.","first-page":"1055","article-title":"Prospective natural history study of central nervous system hemangioblastomas in von Hippel-Lindau disease","volume":"120","author":"Lonser RR","year":"2014","unstructured":"Lonser RR, Butman JA, Huntoon K, et\u00a0al. Prospective natural history study of central nervous system hemangioblastomas in von Hippel-Lindau disease. J Neurosurg. 2014;120(5):1055\u20131062."},{"issue":"1","key":"b8","series-title":"Neurosurgery.","first-page":"71","article-title":"Risk of hemorrhage in hemangioblastomas of the central nervous system","volume":"57","author":"Gl\u00e4sker S","year":"2005","unstructured":"Gl\u00e4sker S, Van Velthoven V Risk of hemorrhage in hemangioblastomas of the central nervous system. Neurosurgery. 2005;57(1): 71\u201376."},{"issue":"9","key":"b9","series-title":"Neuroradiology.","first-page":"981","article-title":"Preoperative liquid embolization of cerebeller hemangioblastomas using N-butyl cyanoacrylate","volume":"54","author":"Murai Y","year":"2012","unstructured":"Murai Y, Kominami S, Yoshida Y, et\u00a0al. Preoperative liquid embolization of cerebeller hemangioblastomas using N-butyl cyanoacrylate. Neuroradiology. 2012;54(9):981\u2013988."},{"issue":"4","key":"b10","series-title":"J Neurointerv Surg.","first-page":"386","article-title":"N-butyl 2-cyanoacrylate (n-BCA) embolization of a cerebellar hemangioblastoma","volume":"3","author":"Munyon C","year":"2011","unstructured":"Munyon C, Chowdhry SA, Cohen ML, Bambakidis NC, Hsu DP N-butyl 2-cyanoacrylate (n-BCA) embolization of a cerebellar hemangioblastoma. J Neurointerv Surg. 2011;3(4):386\u2013389."},{"issue":"2","key":"b11","series-title":"Oper Neurosurg (Hagerstown).","first-page":"135","article-title":"Safety and efficacy of preoperative embolization of intracranial hemangioblastomas","volume":"12","author":"Ene CI","year":"2016","unstructured":"Ene CI, Xu D, Morton RP, et\u00a0al. Safety and efficacy of preoperative embolization of intracranial hemangioblastomas. Oper Neurosurg (Hagerstown). 2016;12(2):135\u2013140."},{"issue":"6","key":"b12","series-title":"J Neurosurg.","first-page":"1492","article-title":"Neurological morbidity and mortality associated with the endovascular treatment of cerebral arteriovenous malformations before and during the Onyx era","volume":"122","author":"Crowley RW","year":"2015","unstructured":"Crowley RW, Ducruet AF, Kalani MY, Kim LJ, Albuquerque FC, McDougall CG Neurological morbidity and mortality associated with the endovascular treatment of cerebral arteriovenous malformations before and during the Onyx era. J Neurosurg. 2015;122(6): 1492\u20131497."},{"key":"b13","series-title":"Stroke.","article-title":"Middle meningeal artery embolization for chronic subdural hematoma: a review of established and emerging embolic agents","author":"Tudor T","year":"2023","unstructured":"Tudor T, Capone S, Vivanco\u2010Suarez J, et\u00a0al. Middle meningeal artery embolization for chronic subdural hematoma: a review of established and emerging embolic agents. Stroke. 2023: e000906."},{"issue":"3","key":"b14","series-title":"Oncol Lett.","first-page":"1125","article-title":"Surgical treatment of solid hemangioblastomas of the posterior fossa: a report of 28 cases","volume":"13","author":"Cui H","year":"2017","unstructured":"Cui H, Zou J, Bao YH, Wang MS, Wang Y Surgical treatment of solid hemangioblastomas of the posterior fossa: a report of 28 cases. Oncol Lett. 2017;13(3):1125\u20131130."},{"issue":"1","key":"b15","series-title":"Neurointervention.","first-page":"45","article-title":"Preoperative embolization of cerebellar hemangioblastoma with onyx: report of three cases","volume":"9","author":"Shin GW","year":"2014","unstructured":"Shin GW, Jeong HW, Seo JH, Kim ST, Choo HJ, Lee SJ Preoperative embolization of cerebellar hemangioblastoma with onyx: report of three cases. Neurointervention. 2014;9(1): 45\u201349."},{"issue":"2","key":"b16","series-title":"Neurosurg Focus Video.","first-page":"V15","article-title":"Hybrid endovascular and microsurgical treatment for a large mesencephalic-cerebellar hemangioblastoma","volume":"1","author":"Song J","year":"2019","unstructured":"Song J, Li P, Tian Y, Zhao X, Wang X, Zhu W Hybrid endovascular and microsurgical treatment for a large mesencephalic-cerebellar hemangioblastoma. Neurosurg Focus Video. 2019;1(2):V15."},{"key":"b17","series-title":"Interv Neuroradiol.","first-page":"157","article-title":"Complications and their management during NBCA embolization of craniospinal lesions","volume":"9","author":"Niimi Y","year":"2003","unstructured":"Niimi Y, Berenstein A, Setton A Complications and their management during NBCA embolization of craniospinal lesions. 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