A case of recurrent hemangioblastoma receiving blood supply from the mastoid and transosseous branches of the occipital artery.

Background: Hemangioblastomas (HBs) typically receive their blood supply from the branches of the intracranial arteries; however, meningeal branches or arteries originating from the external carotid artery are rare because of the intramedullary subpial location of the HBs. Although HB embolization is effective, it carries complication risks.

Case description: A 71-year-old man with a history of incomplete HB resection consulted our hospital with headache, vertigo, and nausea. Neuroimaging revealed a recurrent HB. Angiography demonstrated that the HB was fed by mastoid branch (MB) and transosseous branches (TOBs) from the occipital artery (OA), in addition to the superior cerebellar artery (SCA) and the posterior inferior cerebellar artery (PICA). The patient underwent preoperative embolization with n-butyl-2-cyanoacrylate through the SCA and PICA branches. After embolization for TOBs, which led to feeder occlusion of the OA, the meningeal branch of the MB from the OA was revealed. We hesitated to perform embolization targeting this MB, considering the risk of potential anastomosis to the vertebral artery. Total resection through an enlarged craniectomy was conducted with minimal bleeding. Postoperative magnetic resonance imaging revealed no remnant tumor; however, infarction was observed in the area perfused by the SCA due to embolization of the SCA branches. The symptoms improved after surgery, and the patient was discharged following rehabilitation, with slight ataxia as a sequela.

Conclusion: This is a rare case of recurrent HB receiving a blood supply from the MB and TOBs from the OA. Thus, embolization for TOBs is safe and effective for recurrent HB resection.