Cerebellar Hemangioblastoma Resection Complicated by Postoperative Vasogenic Edema in the Setting of Concurrent Immunotherapy Treatment.

Abstract

Hemangioblastomas are rare, benign vascular tumors of the central nervous system that are often found in the cerebellum, brainstem, or spinal cord. Common clinical symptoms are related to the mass effect, such as headaches, ataxia, and hydrocephalus. While hemangioblastomas frequently present with vasogenic edema, sustained postoperative edema after tumor resection is an unexpected finding. We report a case of cerebellar hemangioblastoma in a 66-year-old male patient with metastatic prostate cancer and progressive headaches, dizziness, and ataxia. Surgical resection was complicated by significant postoperative edema and worsening of symptoms, requiring urgent reoperation. The patient's chemotherapeutic regimen included docetaxel and leuprolide, which have both been reported in cases of vasogenic edema. Chemotherapy drugs induce endothelial cell dysfunction and trigger vascular leakage, resulting in vasogenic edema. Additionally, gonadotropin-releasing hormone (GnRH) agonists such as leuprolide may impair cerebrospinal fluid (CSF) regulation, resulting in increased intracranial pressure and subsequent edema. The combination of immunosuppressive drugs and GnRH agonists in this patient's cancer treatment regimen, along with vascular disruption from the hemangioblastoma itself, may have had a synergistic effect on vasogenic edema development. Our patient's postoperative edema was successfully managed via decompressive laminectomy and placement of a ventriculoperitoneal shunt, with resolution of symptoms seen postoperatively and at the 12-week follow-up. Tumor surgeons should be advised that patients on chemotherapy and immunotherapy agents may be at higher risk of postoperative edema and an associated mass effect on the surrounding structures.