Pre-op Devascularisation of an Intraventricular Haemangioblastoma
Professor Jeffrey P. Kochan, MD
Associate Professor of Radiology and Neurosurgery, Temple University Hospital Philadelphia, USA
Patient History
- 22-year-old male with history of two-week diplopia.
- MRI revealed coincidental finding of large densely hypervascular mass in the fourth ventricle supplied by multiple distal branches of the right posterior-inferior cerrebellar artery (PICA).
- No other focal neurological findings apparent, other than mild divergent gaze after sedation.
Coronal post-gadolinium
Sagittal pre-gadolinium
Procedure
- Tumour embolised using Bead Block™ 100-300μm through a microcatheter, advanced distally through a 4Fr vertebral catheter into the left posterior cerebellar artery.
- Infusion discontinued when normal distal left PICA arterial anatomy was visualised.
- After embolisation a small residual trunk of vessel was satisfactorily coiled with two .010” liquid platinum microcoils.
- Post-embolisation angiography showed significant reduction of approximately 80% in tumour neovascularity from each of the PICAs.
- No change to neurologic examination or dysconjucate gaze post-embolisation.
Outcome
- Satisfactory embolisation of bilateral PICA supply to an intra-fourth ventricular hypervascular mass.
Pre-embolisation: right vertebral artery
Pre-embolisation: left vertebral artery
Pre-embolisation, lateral view: right vertebral artery
Pre-embolisation, lateral view: left vertebral artery
Post-embolisation: left vertebral artery
Post-embolisation, lateral view: left vertebral artery