Suprasellar Hemangioblastoma Mimicking a Craniopharyngioma: Result of Extended Endoscopic Transsphenoidal Approach—Case Report

Abstract

Hemangioblastoma in the suprasellar region is rare. We present a case of a suprasellar hemangioblastoma that underwent surgical resection using an extended endoscopic transsphenoidal approach. A 64-year-old female patient presented with headache and decreased visual acuity for the last four years, computed tomography (CT) and magnetic resonance imaging (MRI) revealed a 2.5 cm irregular lesion in the suprasellar region. Our preoperative presumptive diagnosis was craniopharyngioma. The patient underwent an extended endoscopic transsphenoidal approach, the mass was subtotally removed. An endoscopic endonasal repair was needed due to the cerebrospinal fluid (CSF) leak. However, 1 month later, the patient got disturbance of consciousness because of the hydrocephalus. Ventriculoperitoneal shunt was used to solve the problem. Pathological findings were compatible with hemangioblastoma. Suprasellar hemangioblastoma is very rare. Any highly vascular lesions located in the suprasellar region should alert the surgeon to the possibility of hemangioblastoma. Extended endoscopic transsphenoidal approach adopted by us should not be the first choice of the treatment procedure for this kind of large and vascular tumor.

Supratentorial haemangioblastoma without von Hippel–Lindau syndrome in an adult: A rare tumor with review of literature

“…[ 16 ] On reviewing the literature from 1902 to 2014, we found 57 cases of supratentorial HBL without VHL as shown in Table 1 . [ 6 8 9 15 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 ] On reviewing the literature, we found that supratentorial HBL affected patients ranging from 3 months to 80 years with maximum cases belonging to 20–30 years and 40–50 years age group. Among the infants, only one case was found, thus making it a rare tumor in infancy.…”

Sporadic Pituitary Stalk Hemangioblastoma: A Rare Case Report and Review of the Literature

“…There are only 132 previous reports in the literature of supratentorial hemangioblastomas [6]. Reports of intrasellar [7], suprasellar [8], and intraventricular locations [9] have been documented. Although histologically benign, occasionally, the tumor may spread along the subarachnoid space and especially after a surgical procedure, but no metastases have been testified.…”

“…high vascularity, open craniotomy is generally preferred in order to prevent uncontrolled bleeding and partial excision, but this approach results more often in pituitary stalk excision as compared to the transsphenoidal approach [7,9,16]. Total removal should be the main surgical goal, as these benign neoplasms tend to easily recur after partial excision.…”

Suprasellar Hemangioblastoma Unrelated to von Hippel-Lindau Disease Successfully Treated through Extended Transsphenoidal Approach: Diagnostic Value of Von Hippel-Lindau Disease Gene-Derived Protein

“…Various surgical approaches have been adopted, but great care is required because of the highly vascular character and resultant extreme bleeding tendency (►Table 2). Three patients experienced massive bleeding during surgery, 5,14,15 and one patient almost died. 5 Total removal and lower removal rates show obvious differences in outcome.…”

“…Only 12 previous cases of suprasellar hemangioblastoma were identified as VHLD-unrelated sporadic cases (including two suspected cases). [5][6][7][8][9][10][11][12][13][14][15][16] However, all these cases were only diagnosed based on clinical screening and confirmation of family history.…”