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.