• Daisuke Kawauchi, Yoshinori Higuchi, Shiro Ikegami, Akihiko Adachi, Ko Ozaki, Izumi Suda, Eiichi Kobayashi, and Yasuo Iwadate.
• Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan. Electronic address: daisukee@gmail.com.
• World Neurosurg. 2019 Sep 1; 129: e733-e740.

BackgroundThe surgical resection of large supracerebellar hemangioblastomas (SHBs) is exceptionally challenging due to their vascularity and deep anatomic location and is associated with a high risk of postoperative complications and mortality. Access to the posterior incisural space can be achieved by either an infratentorial supracerebellar approach or occipital transtentorial approach (OTA). However, the optimal surgical strategy has not yet been established. Here, we report 2 cases of large SHBs that were successfully and safely resected via a unilateral OTA with multimodal assistance.Case DescriptionTwo patients presented to our hospital with ataxia due to large, solid SHBs. After preoperative embolization, gross total resection of the SHBs was achieved via an OTA. Furthermore, endoscopic assistance was used to resect the remnant portion of the tumor in the second patient. Both patients experienced transient ataxia but were discharged from the hospital without serious complications.ConclusionsThe combination of an OTA with preoperative embolization and endoscopic assistance may reduce the intraoperative risk and contribute to improved outcome in patients with such clinically challenging tumors.Copyright © 2019 Elsevier Inc. All rights reserved.

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