Autonomic Dysfunction Following Surgical Resection of Cervicomedullary Hemangioblastoma: A Case Report and Literature Review.

Hemangioblastomas are rare vascular tumors of the central nervous system, most frequently arising in the cerebellum but occasionally in the spinal cord or brainstem. Their occurrence at the cervicomedullary junction is uncommon yet clinically significant due to the potential for severe neurological and autonomic complications. We report the case of a 63-year-old man who presented with progressive gait ataxia and intermittent loss of consciousness. MRI revealed a 3.3 × 4.5 cm enhancing lesion at the cervicomedullary junction, compressing the brainstem and causing hydrocephalus. Preoperative embolization of feeding vessels from the posterior inferior cerebellar and internal carotid arteries was performed, followed by suboccipital craniotomy and complete tumor excision. Postoperatively, the patient developed recurrent orthostatic hypotension requiring prolonged intensive care, vasopressor therapy, and coordinated multidisciplinary management, consistent with autonomic dysfunction from disruption of brainstem autonomic centers. This case highlights the challenges of managing cervicomedullary hemangioblastomas, emphasizing the need for careful preoperative planning, precise surgical execution, and individualized postoperative care, as even histologically benign tumors can pose life-threatening risks due to their critical location.