Hemangioblastoma, especially medulla oblongata hemangioblastoma, is a great challenge for neurosurgeons due to its highly vascularized property and neighbor to the pivotal neural structures of the brainstem.1,2 Surgical resection has been recommended as the main therapeutic option for symptomatic lesions.3,4 However, how to remove the huge solid tumor en bloc, instead of the relatively small cystic counterpart, without any neurologic dysfunction still remains elusive.5 Here, we demonstrate the case of a 28-year-old female who presented with headache for 2 months. A series of images illustrated multiple hemangioblastomas including a huge (maximum diameter >3 cm) solid medulla oblongata hemangioblastoma and a cerebellum hemangioblastoma. Surgical resection via the suboccipital approach was chosen because of the increasing risks of hydrocephalus and brainstem compression. According to the principle of hemangioblastoma resection, dissecting through the pia plane will ensure total removal of the tumor. Unfortunately, this is difficult to achieve when a tumor is huge and solid because the surgical plane is obscure and even vanishes. In Video 1, we demonstrated how to deal with the tumor in such a situation using blunt dissection and sharp dissection. In addition, appropriate traction assisted us in creating a detachable plane, collectively providing an opportunity to remove the tumor en bloc without uncontrollable bleeding and functional brain tissue injury. With the help of these technical nuances, a curative resection of the tumor was finally achieved and the patient preserved intact neurologic function. The patient gave informed consent for the procedure and verbal consent for the publication of her image.
Keywords: Cerebellum; Hemangioblastoma; Medulla oblongata; Microsurgical resection; Pia plane.
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