Selection of surgical approach for cerebellar hemangioblastomas based on venous drainage patterns

Cerebellar hemangioblastomas remain surgically challenging because of the narrow, deep surgical corridors and tumor hypervascularity. Various approaches are used according to location, but optimal have not been established. We propose a system based on venous drainage systems facilitate planning achieve acceptable neurological outcomes. were divided into five types main systems: suboccipital draining transverse sinus (TS) or torcula, tentorial straight sinus, petrosal superior (SPS), quadrigeminal galenic system, tonsillar TS torcula in conjunction with jugular bulb SPS. Microsurgical patient outcome retrospectively reviewed this classification. This study included 17 patients who underwent 21 operations for resection 19 cerebellar hemangioblastomas, classified 9 suboccipital, 4 tentorial, 2 petrosal, quadrigeminal, tonsillar. Standard craniotomies utilized occipital transtentorial approach (OTA), supracerebellar infratentorial retrosigmoid OTA midline hemangioblastomas. Gross total was achieved all except one. Two large (tonsillar quadrigeminal) required second-stage operation which finally gross removal. No single had significantly higher incidence postoperative deficits. Selection optimum successful systems. Understanding growth extension respect is critical select appropriate approach.