Cerebellar hemangioblastoma presenting with obstructive hydrocephalus in a 36‒week pregnant patient: A case report

The presentation of intracranial tumors during pregnancy is relatively uncommon. We report a case of cerebellar hemangioblatoma presenting with brainstem compression and obstructive hydrocephalus during the third trimester of pregnancy. A 29‒year‒old woman visited our hospital presenting with headache and nausea. Magnetic resonance imaging revealed a well‒circumscribed mass in the left cerebellar hemisphere with diffuse brain edema, brainstem compression and hydrocephalus. The tumor was strongly enhanced by gadolinium. Vertebral angiography demonstrated a tumor stain supplied by the left posterior cerebellar artery and superior cerebellar artery, draining into transverse sinus. We delivered the baby by performing cesarean section, and then removed the tumor by suboccipital and occipital transtentorial approach. The tumor was accompanied by a high‒flow arteriovenous shunt. After clipping off the feeding arteries, we detached the tumor from the cerebellum and achieved total en bloc resection. Histopathological examination confirmed the diagnosis of hemangioblastoma. The postoperative course was uneventful, and the patient was discharged one month after the operation with her baby. Previous reports suggest that the presentation of cerebral tumors during pregnancy is related to the increased circulating blood volume and serum estrogen concentration, leading to an increase in the tumor volume and the aggravation of the brain edema. Since we can expect tumor shrinkage after child delivery due to the normalization of the circulating blood volume and hormonal changes, elective tumor removal after delivering the baby can be a treatment option. However, another reported case shows neurological deterioration after child delivery; the optimal course of treatment for cerebral tumors during pregnancy is still controversial. We must plan the treatment strategy based on the condition of each patient.