Preoperative Embolisation of Cerebellar Hemangioblastomas Using N-butyl Cyanoacrylate (NBCA) – Techniques, Efficacy and Safety Profile: 24 Years ’Experience from a Tertiary Care Center (India)

Purpose: Cerebellar hemangioblastomas (CHBs) are highly vascular posterior fossa tumors, often posing surgical challenges. Preoperative embolization, particularly using N-butyl cyanoacrylate (NBCA), may reduce blood loss, operative time, and improve resection outcomes, especially in recurrent or residual tumors. Materials and Methods: This retrospective study reviewed records of patients with CHBs who underwent preoperative embolization followed by surgery between January 2001 and April 2024. Of 12 patients, 9 with complete records were included. Data analyzed included demographics, angiographic features, embolized arteries, embolic agents, complications, timing of surgery, operative time, blood loss, extent of resection, and discharge status. Results: Nine patients (8 males, 1 female) were included; one had von Hippel-Lindau syndrome. Five tumors were recurrent or residual. Angiography showed a mean vascularity reduction of 70% (range: 50–95%). NBCA (9–25%) was used in 8 cases for pial supply. Embolization was uneventful in 8 patients; one developed a right superior cerebellar artery infarct without clinical deficit. Surgery followed within 24 hours in 8 patients. Mean blood loss was 430 mL (range: 50–1200 mL), and mean operative time was 4.8 hours (range: 2.5–6 hours). Neurological status at discharge was stable or improved in all cases. Conclusion: Preoperative embolization is a safe and effective adjunct in CHB surgery. NBCA is a reliable, cost-effective embolic agent in skilled hands. It reduces intraoperative blood loss and facilitates complete tumor excision, especially in challenging recurrent or residual lesions.