Hemangioblastoma with Massive Bleeding

A case of hemorrhage from hemangioblastoma is reported. A 52-year-old female was admitted with an episode of sudden-onset consciousness disturbance and double vision. Six years previously she had been treated by a ventriculo-peritoneal shunt, radiation therapy and partial removal of a cerebellar hemangioblastoma. Computed tomography showed a massive hemorrhage around the recurrent tumor in the left cerebellar hemisphere and a ventricular bleeding. Evacuation of the hematoma was immediately performed. The tumor could be removed only partially because it bled easily. Postoperative left vertebral and carotid angiography disclosed that the tumor was mainly supplied by the left superior cerebellar and the tentorial arteries. In the second operation, the left superior cerebellar artery was clipped temporarily through the subtemporal approach, and the tumor was extirpated totally through the suboccipital approach. Histological examination confirmed hemangioblastoma. Mechanism of the massive hemorrhage from hemangioblastoma is discussed.