In this session of The Neurosurgical Case Room, we focus on the management and operative strategy for hemangioblastoma, one of the most vascular tumors encountered in posterior fossa surgery. The discussion centers on surgical planning, approach selection, and the principle of en bloc resection to prevent uncontrolled bleeding. Key nuances such as preservation of venous drainage, sequential control of arterial feeders, and avoidance of internal debulking are emphasized. We also address decision-making in cerebellar lesions and the clinical context of Von Hippel–Lindau disease.