Hemorrhage into Cystic Vestibular Schwannoma Following Stereotactic Radiation Therapy

Abstract

The occurrence of a hemorrhage into a vestibular schwannoma is a rare phenomenon. Several reports, however, indicate a risk profile for a subgroup of patients with vestibular schwannoma which show hypervascularity in the histopathological examination. Cystic formation, large size, mixed Antoni type and anticoagulation therapy seem to enhance the risk of tumor hemorrhage. We report on a patient with a large cystic vestibular schwannoma who died from fatal bleeding into the tumor 15 months following stereotactic radiation therapy. Since hemorrhage seems to be a relevant risk in large cystic vestibular schwannomas, a surgical treatment should be preferred whenever possible.

Zusammenfassung

Das Auftreten einer Tumorblutung in einem Akustikusneurinom (AN) ist selten. In der Literatur gibt es nur wenige Berichte, die ein Risikoprofil für das Auftreten dieser Blutungen beschreiben, das durch vermehrte Gefäßbildung in der histopathologischen Untersuchung gekennzeichnet ist. Zystenbildung, Tumorgröße, Antoni A und B-Mischtyp und Antikoagulation scheinen das Risiko einer Blutung zu erhöhen. Wir berichten über eine Patientin mit großem, zystischen AN, die 15 Monate nach einer hypofraktionierten stereotaktischen Radiotherapie an einer tödlichen Blutung verstorben ist. Da eine Tumorblutung ein relevantes Risiko bei zystischen AN darstellt, sollte wenn möglich die neurochirurgische Resektion einer konservativen Behandlung vorgezogen werden.

Key words

vestibular schwannoma - hemorrhage - stereotactic radiation therapy

Schlüsselwörter

Akustikusneurinom - Tumorblutung - stereotaktische Radiotherapie

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