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

This report presents a patient with a cerebellar hemangioblastoma associated with obstructive hydrocephalus and a saccular superior cerebellar artery (SCA) aneurysm who was successfully treated using a three-stage approach that included ventriculoperitoneal shunting, preoperative endovascular embolization of the tumor vasculature and aneurysm with a low viscosity non-adhesive liquid embolic agent, and total microsurgical tumor removal. Removal of these tumors is associated with a high risk of profuse intraoperative blood loss, cerebral edema, and other equally dangerous complications. Our case was complicated by a tumor feeder aneurysm, which increased the risk of spontaneous subarachnoid hemorrhage and intraoperative aneurysm rupture. A three-stage approach allowed radical and safe removal and resulted in improved neurological symptoms.