Ruptured Medullary Hemangioblastoma Mimicking a Craniocervical Junction Dural Arteriovenous Fistula with a Pseudoaneurysm

Abstract

Hemangioblastomas (HBMs) are rare vascular tumors commonly located in the posterior fossa of adults. A mid-50s patient presented with sudden unconsciousness. Computed tomography scans revealed acute hemorrhages around the posterior fossa, predominantly in the subarachnoid space. Digital subtraction angiography (DSA) revealed an 8-mm round lesion filled with contrast agent, fed by the C1 segmental artery of the left vertebral artery (VA), showing early venous drainage to the spinal cord and brainstem. Emergent embolization was attempted under suspicion of a ruptured dural arteriovenous fistula, resulting in parent artery occlusion due to feeder selection failure. Follow-up DSA after a month depicted a persistent aneurysm via collaterals from both VAs. Consequently, the decision was made to proceed with surgical intervention, leading to the resection of the lesion, confirming its diagnosis as a HBM through histological examination. This case underscores the potential for misdiagnosis when HBMs with an intratumoral shunt mimic vascular shunt lesions.

Posterior fossa Hodgkin’s lymphoma radiographically mimicking an arteriovenous malformation: illustrative case

“… 7 – 9 Furthermore, significantly vascularized tumors can sometimes be mistaken for vascular malformations, potentially confounding the initial diagnostic workup. 10 – 13 A few cases of hypervascular anaplastic oligodendrogliomas have been reported in which the original radiographic diagnosis was arteriovenous malformation (AVM) based on magnetic resonance imaging (MRI). 10 , 11 Similarly, cases of hypervascular glioblastomas (GBMs) and hemangioblastomas have been initially mistaken for AVMs based on significant flow voids on MRI and arteriovenous shunting on angiography.…”

“… 10 , 11 Similarly, cases of hypervascular glioblastomas (GBMs) and hemangioblastomas have been initially mistaken for AVMs based on significant flow voids on MRI and arteriovenous shunting on angiography. 12 , 13 In all of these cases, the patients underwent conventional catheter angiography to evaluate each lesion’s angioarchitecture before obtaining a final tissue diagnosis due to significant tumor neovascularization.…”