Noncystic cerebellopontine angle hemangioblastoma: A case of an atypical location

INTRODUCTION: Extra-axial cerebellopontine angle (CPA) hemangioblastoma is a rare condition in which the correct differential diagnosis from other CPA lesions can affect the best treatment choice. These are benign tumors that are highly vascularized and mostly present in the cystic form. About twenty-six cases have been reported in the literature with this same location and with a noncystic aspect. PRESENTATION OF CASE: We report a case of a 63-year-old male with a complaint of progressive headache associated with imbalance and difficulty walking. Neurological examination showed discreet facial paresis, left dysmetria and mild gait ataxia. Magnetic resonance imaging (MRI) showed a solid mass with isointensity on T1-weighted sequences; hypointensity and a heterogeneous appearance on T2-weighted sequences; and intense homogeneous contrast enhancement located in the left CPA region extending superiorly to the tentorial notch. The first diagnosis was meningioma, but during the microsurgical suboccipital retrosigmoid approach, it was observed that the lesion was extremely bloody with several vessels on its surface. We achieved gross total resection, and the pathology confirmed hemangioblastoma. DISCUSSION: Although it is rare, hemangioblastoma should be one of the differential diagnoses when dealing with CPA solid lesions with high contrast enhancement and heterogeneity on T2-weighted MRI. Analysis of the radiological characteristics allows a greater chance of confirmation and is one of the main tools for surgical planning. CONCLUSION: Correct preoperative evaluation and the possibility that hemangioblastoma may arise from the CPA can avoid trans-operative risks mainly related to bleeding and can improve results.