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| Name | Challenging pediatric cerebellar hemangioblastoma surgery | @axonhospitals |
| Video Uploader | Video From Axon Hopsitals |
| Upload Date | This Video Uploaded At 25-05-2023 13:56:03 |
| Video Discription | I am presenting a case of a difficult pediatric brain tumor - posterior fossa hemangioblastoma operated by me. A 14-year-old girl presented with a history of frequent headaches and decreased vision in both eyes for a few days. She was initially seen by an ophthalmologist who found papilledema in both eyes and advised an MRI of the brain. Her MRI showed a large left cerebellar contrast-enhancing tumor compressing the brainstem and causing moderate hydrocephalus. This lesion was solid cystic with the presence of flow voids in the periphery, suggestive of a cerebellar hemangioblastoma. Hemangioblastoma is a highly vascular tumor, similar to an arteriovenous malformation, which can cause significant bleeding during surgery. If the tumor is very vascular and deep-seated, preoperative digital subtraction angiography (DSA) is performed, and angiographic embolization of the tumor is done to reduce intraoperative bleeding. This patient was immediately scheduled for surgery, and a complete excision of the tumor was achieved. There was profuse bleeding during surgery, which was controlled, as shown in the operative video. Usually, brain tumors are removed in small pieces to avoid damage to the normal brain tissue. However, in the case of this hemangioblastoma, removing the tumor in small pieces causes massive bleeding. Therefore, it is always removed in one piece. Gradual devascularization of the tumor from the periphery is performed to shrink its size. This tumor has multiple arterial feeders, which are coagulated from the periphery, but the draining vein is preserved until the last step. After the surgery, the patient had no neurological deficits. Her headaches decreased, and her vision significantly improved. She was discharged after 5 days. She required 2 blood transfusions during surgery. Cerebellar hemangioblastoma in children is sometimes a part of a syndrome called von Hippel-Lindau (VHL) syndrome, which includes adrenal tumors, retinal tumors, and various clinical manifestations. On clinical examination, no other VHL manifestations were found. She was found to be obese for her age (weight: 70kg). She will now be referred to a pediatric endocrinologist for further hormonal workup. Her final histopathology confirmed hemangioblastoma, WHO grade 1. |
| Category | Education |
| Tags | surgery | surgeon |
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