br Conclusion br Introduction Hemangioblastomas are predomin

Conclusion
Introduction Hemangioblastomas are predominantly present in the cerebellum, eukaryotic initiation factor stem, and spinal cord. They rarely occur in supratentorial locations. These tumors may occur sporadically or be associated with von Hippel–Lindau disease (VHL). Here we report a case of a 52-year-old woman with a broad dural-based isolated supratentorial hemangioblastoma with hypervascular supply mimicking a meningioma.
Case report A 52-year-old, right-handed woman presented with short-term alteration of consciousness after experiencing convulsions. In addition, she experienced intermittent headaches and dizziness over the course of 1 month. She had no family history of cancer or inherited diseases. Her physical and neurological examinations upon admission were unremarkable. Hematological study results were within the normal range. Brain computed tomography revealed an intensely contrast-enhanced 4.2 cm × 3.9 cm solid mass with perifocal edema in the left frontal area. Magnetic resonance imaging (MRI) revealed that the tumor was attached to the dura using intense contrast enhancement (Figures 1A–1C). Preoperative angiography was performed for the therapeutic embolization of the hypervascular tumor (Figures 1D and 1E). Successful devascularization of the tumor via the left middle meningeal artery was performed using 150–255-μ polyvinyl alcohol particles (Figures 1F and 1G). On the following day, left frontal craniotomy was performed for tumor resection. The tumor adhered to the dura with moderate vascularity, without invading the brain parenchyma. The tumor and attached dura were resected en bloc (Figure 2). Total blood loss during the operation was 200 mL. Histopathological examination revealed numerous branching capillary channels, capillary venules, intervascular stromal cells, and lipoblast-like cells. Immunostaining revealed that the stromal cells were positive for neuron-specific enolase, CD56, D2-40, and factor VIII and negative for CD31, CD34, S-100 protein, CD10, glial fibrillary acidic protein, and alpha-inhibin (Figure 3). These findings were consistent with the characteristics of hemangioblastomas. The patient recovered well after the operation. Follow-up MRI 4 months after the operation revealed no evidence of residual mass or recurrence (Figures 1H and 1I). Furthermore, a second follow-up MRI, 2 years after the operation revealed no recurrence.
Discussion Hemangioblastomas have been reported at various locations in the central nervous system. Supratentorial hemangioblastomas are extremely rare. Between 1902 and 2013, approximately 132 cases of supratentorial hemangioblastomas were reported. In our patient, the tumor was located in the left frontal area. Radiographically, hemangioblastomas appear as cystic lesions with a mural nodule. Solid tumors are less common than cystic tumors are. Approximately seven cases of isolated dural-based tumors were reported before 2007. In our patient, MRI revealed an intensely contrast-enhanced, well circumscribed, broad, dural-based lesion; its pattern resembled a meningioma with perifocal edema. The advantages of preoperative embolization remain unclear. Cornelius et al observed a hemorrhage after the particle embolization of a hemangioblastoma. Liu et al reported temperate forest biome the selective preoperative embolization of a hemangioblastoma is a safe, effective, and reliable adjuvant therapy for complete surgical resection of the tumor. In our patient, preoperative angiography revealed that the hemangioblastoma was mainly supplied by the left middle meningeal artery and branches of the left anterior and middle cerebral arteries. Successful preoperative devascularization was performed through the right femoral arterial approach, and total blood loss during the operation was only 200 mL. Blood loss majorly occurred during craniotomy and not during tumor resection. Therefore, preoperative embolization of a hemangioblastoma can minimize blood loss and shorten operation time.