Solid hemangioblastoma in the cerebellopontine angle: Importance of external carotid blood supply with regard to the probable site of origin and preoperative embolization

BACKGROUND: Hemangioblastoma (HBL) is rare in the cerebellopontine angle (CPA) with questionable origin and limited access for circumferential dissection and “en-bloc” excision. We report a case of surgical removal of large solid CPA-HBL and discuss the pattern of blood supply suggesting its origin and indicating preoperative embolization. CASE DESCRIPTION: The solid and highly vascular CPA-HBL had feeders mainly from neuromeningeal division of ascending pharyngeal branch of external carotid artery, suggesting true extra-axial origin. We could achieve “en-bloc” excision without significant blood loss or morbidity using preoperative embolization. CONCLUSION: Large solid HBL is rare in CPA necessitating arduous “en-bloc” excision. The pattern of blood supply probably indicates the site of origin and safety of preoperative embolization.