Taming a Hypervascular Posterior Fossa Tumor: Feeder-Specific Embolization and Resection of a Solid Cerebellar Hemangioblastoma in von Hippel–Lindau Disease

Abstract Hemangioblastomas are highly vascular tumors of the central nervous system and may occur sporadically or in association with von Hippel–Lindau (VHL) disease. Solid cerebellar hemangioblastomas represent a surgically challenging subset due to their marked vascularity and increased risk of intraoperative bleeding. We report a 52-year-old male with VHL disease who presented with progressive gait imbalance and headache and was found to have a vascular cerebellar lesion arising from the roof of the fourth ventricle with associated hydrocephalus. Systemic evaluation revealed additional spinal, renal, and pancreatic involvement. Preoperative digital subtraction angiography demonstrated dominant supply from branches of the posterior inferior cerebellar artery, allowing feeder-specific endovascular embolization. Subsequent microsurgical excision was performed via a midline suboccipital approach, achieving gross total resection with minimal blood loss. Histopathology confirmed hemangioblastoma (WHO Grade I). This case highlights the role of careful angiographic evaluation and selective embolization in facilitating safe surgical management of solid cerebellar hemangioblastomas in patients with VHL disease.