A 58-year-old man presented with a seizure and loss of consciousness. Neuroimaging revealed a highly vascularized 5.7 x 5 cm solid mass in his right temporo-parietal region. Biopsy determined the mass was a solid supratentorial hemangioblastoma, a rare tumor. Further tests ruled out Von Hippel-Lindau disease. The patient underwent partial resection of the mass, improving his symptoms. Solid supratentorial hemangioblastomas occurring as single lesions unrelated to Von Hippel-Lindau disease are infrequent and atypical clinical presentations like this case are rarely reported.

1. 1
Introduction
This type of lesions located in the supratentorial space is
something infrequent in daily neurosurgical practice, less than
10% of the cases reported in the last 10 days; the presentation of
these lesions in this space, in their solid form, not associated with
VHL disease is atypical. When these types of lesions appear in any
of their forms of presentation and morphological characteristics
in the supratentorial space, they are generally located in the
frontal and inter-hemispheric region, cases in their solid form and
as a single lesion at least in the publications made on the subject
during the last 5 years [1-3].
Diagnostic criteria for VHL disease are as follows: - One or
more lesions within the CNS - Presence of visceral lesion (often
in the kidney or pancreas) - Family history of the disease with
a positive family history, it is sufficient to detect a single lesion
regardless of its location to establish the diagnosis. In the case of
patients who do not present a positive family history, it is necessary
to confirm two or more lesions in the CNS, or a visceral lesion in
addition to another located in the brain or spinal cord [4-7].
Clinical Case
We present the case of a 58-year-old patient with a history
of Arterial Hypertension disease without a family history of
neoplastic disease or phakomatosis, with a seizure for more
than 15 minutes and loss of consciousness for approximately
40 minutes in the intensive care unit and emerging. He is given
medical attention under neurointensive treatment, interpreting
the clinical manifestations as an episode of seizure status in a post-
stroke state at the time of his reseption.  Positive data on physical
examination:
• High blood pressure figures (180/120 mmHg)
• Glasgow Scale for Coma 7/15 points
• Physical examination of the optic erve system: bilateral
papilla edema
• Several neuroimaging studies were carried out in order to
establish a certain diagnosis in the patient:
• Simple and contrast computed axial tomography (CT) of the
skull
• Angio-CT Scan
• Simple and contrasted Magnetic Resonance (MRI).
The contrast CT Scan study describes an image that impresses
with the presence of a conglomerate of vessels in the right
temporo-parietal region, which captures contrast in its entirety
and measures 5.7 x 5 cm, is nourished by the branches of the
Open Access
Solid Supratentorial Hemangioblastoma not associated with Von
Hippel Lindau disease: Clinical case
Damian Lastra Copello1
, Yohana Camejo Sánchez2
1
1st
Degree Specialist in Neurosurgery, Diploma in Emergency and Intensive Care, Dr. Miguel Enriquez General Hospital, University
of Havana, Cuba
2
1st
DegreeSpecialistinNeurosurgery,ComprehensiveGeneralMedicineSpecialist.DiplomainEmergencyandIntensiveCare,Cuba
*Correspondence to: Damian Lastra Copello, 1st Degree Specialist in Neurosurgery, Diploma in Emergency and Intensive Care,
Dr. Miguel Enriquez General Hospital, University of Havana, Cuba
Received: 02 August 2021; Accepted: 01 September 2021; Published: 08 September 2021
Copyright: © 2021 Copello DL, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Case Study
Journal of Neurology and Brain Research
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Abstract
Supratentorial Hemangioblastoma is a rare neoplastic entity of the Central Nervous System, the classification of the World Health Organization in 2016
for tumors of the Central Nervous System, classifies this lesion as grade 1 non-meningothelial mesenchymal tumor, lesion highly vascularized whose most
frequent differential diagnosis are Brain Metastases, Meningiomas and Arteriovenous Malformations. Case presentation: Patient with a seizure episode
and marked deterioration of his state of consciousness, who through neuroimaging studies is diagnosed with a supratentorial lesion that captures contrast in
its entirety highly vascularized Discussion: The location of hemangioblastomas in the supratentorial space as a single lesion , solid, not associated with Von
Hippel-Lindau disease, constitutes a rare entity; very few cases with these characteristics and clinical presentation in Convulsive Status have been described
in the reviewed literature.
Keywords: Hemangioblastoma; Mesenchymal; Meningothelial, Neoplastic; Cystic; Vermix

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Copello D L et al., (2021) 1: 001-004
Doi: 10.47755/2766-9661.1000108
right middle cerebral artery, associated with edema that collapses
and displaces the ventricular system to the left 1cm [Figure 1,2].
Figure 1: Contrast CT Scan and MRI image study of the skull.
Figure 2: Reconstructive image of skull Angio -CT Scan.
A right parieto-occipital supratentorial osteoplastic craniotomy
was performed as a surgical approach, achieving partial excision
of the lesion and obtaining a sample of tumor tissue for anatomo-
pathological study where the following images were verified and
described for microscopic observation [Figure 3].
Figure 3: Microscopic image of post-surgical biopsy.
The following characteristics are observed in the microscopic
slide:
• Lipid-laden cytoplasmic cells that form the stroma
• Numerous capillaries without intervening nervous tissue
• Mast cells.
• Parakeets
• Polygonal stromal cells
The definitive diagnosis is established by biopsy of brain tumor
tissue, concluding the case with a diagnosis of right parieto-occipital
solid supratentorial hemangioblastomas. Other imaging studies
were performed during the postoperative period and the patient’s
hospital stay:
• Abdominal Ultrasound (USD)
• Lung CT
• MRI of the Spine
A retina and fundus examination was performed with
the collaboration of Ophthalmology Specialists; There were no
alterations to the physical examination or the presence of lesions
in other organs in the imaging studies performed, ruling out VHL
disease as a possible cause of the lesion described.
Post-surgical status of the patient at 72 hours.
• Disorientation in space
• Sensory dysphasia
• No motor deficit
• Glasgow scale for coma 14/15 points
Considerations in relation to the case
• Extension studies (USD, Chest X-ray, retinal examination,
fundus, determination of vanillylmandelic acid in urine in 24
hours) should be performed before surgical treatment if the
clinical condition of the patient allows it.
• The determination of vanillylmandelic acid is the study of
choice for the diagnosis of pheochromocytoma in the case
of visceral lesion verified by imaging, allowing differential
diagnosis to be carried out.
• Every neurosurgical patient undergoes a treatment process that
includes, among other pillars, surgery as the central axis and
the treatment of possible complications that may appear, as
well as adjunctive therapy to apply to a certain neurosurgical
pathology.
• Surgery with the advent of endovascular therapy prior to it and
microsurgical approaches constitutes a fundamental pillar in
the treatment of these lesions.
• The use of beta-blockers such as propanolol, with the aim of
achieving blood flow redistribution and reducing bleeding
during surgery is a therapy to consider during the treatment
of these cases.
• The careful surgical planning guided by neuro-imaging as well
as the maximum safe resection during the surgical act of this
type of lesions are of vital importance and mandatory in the
treatment of these lesions.

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Copello D L et al., (2021) 1: 001-004
Doi: 10.47755/2766-9661.1000108
• Lowering intracranial pressure with tumor resection and
obtaining a tissue sample for biopsy are fundamental objectives
of surgery.
• With surgery, partial excision of the lesion was achieved,
improving the clinical status of the patient and obtaining tissue
for biopsy.
• The tissue study allowed to draw up guidelines to start neuro-
oncological treatment (radiotherapy, ganma Knyfe )
• It is necessary to register a greater number of cases and the
use of therapeutic variants individually to gain experience and
establish, based on evidence, the ideal protocol for treating these
patients. [8-10]
Discussion
The most frequent site of localization of hemangioblastomas is
in the infratentorial space of the posterior fossa, its diagnosis should
suggest the presence of associated VHL disease, so it is essential to
carry out relevant extension studies with the objective of determining
the presence of one or more lesions in other organs that can confirm
or rule out the diagnosis of the disease. Neuroimaging studies are of
vital importance to establish a correct diagnosis and surgical planning.
When performing the microscopic examination, due to the high
vascularization that these types of tumors present, in addition to
stromal cells, lipids in the cell cytoplasm and angiogenesis processes,
the presence of intratumoral micro-hemorrhages can be observed.
The most frequent symptom that patients with hemangioblastoma
present is headache, which when the lesion grows rapidly, behaving
as an occupying mass of space within the cranial vault, triggers an
increase in intracranial pressure that translates and expresses clinically
with signs and symptoms of Endocranial Hypertension Syndrome
(HES).
Thetreatmentofchoicecurrentlyemergingforhemangioblastoma
is surgery; the use of multimodal therapy contributes to the
considerable decrease in mortality in these patients, statistically
determined by up to 24% of all reported cases. The rate of tumor
recurrence is estimated to be between 16% and 30% of cases. [11-15]
Conclusion
Hemangioblastoma is a rare CNS neoplastic entity, whose
differential diagnosis is Brain Metastases, Meningiomas,
Arteriovenous Malformations and lesions with a cystic component.
The location of hemangioblastomas in the supratentorial space as a
single, solid lesion, not associated with Von Hippel Lindau disease
is infrequent, as is its clinical presentation in Convulsive Status. The
surgery made it possible to improve the clinical status of the patient,
giving her the possibility of receiving cancer treatment and thus
perpetuating and improving her quality of life.
Conflict of interest: No
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Doi: 10.47755/2766-9661.1000108 Copello D L et al., (2021) 1: 001-004
Citation: Copello DL, Sánchez YC. “ Solid Supratentorial
Hemangioblastoma not associated with Von Hippel Lindau disease:
Clinical case” J Neuro Brain Res (2021): doi: 10.47755/2766-9661.1000108