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CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(01): 221-227
DOI: 10.4103/ajns.AJNS_287_20
Case Report

“When the Benign Bleed” vestibular schwannomas with clinically significant intratumoral hemorrhage: A case series and review of the literature

Peter Woo
Department of Neurosurgery, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
,
Pak-Lun Lam
1   Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
,
Yuki Ip
Department of Neurosurgery, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
,
Timothy Chan
2   Department of Anatomical Pathology, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
,
Oliver Ng
2   Department of Anatomical Pathology, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
,
Marco Kwan
Department of Neurosurgery, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
,
Hoi-Tung Wong
Department of Neurosurgery, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
,
Alain Wong
Department of Neurosurgery, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
,
Kwong-Yau Chan
Department of Neurosurgery, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
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Vestibular schwannomas (VSs) are slow-growing benign neoplasms commonly located at the cerebellopontine angle. Although clinically significant hemorrhagic VSs are rarely encountered with only 75 patients previously reported, they could be life threatening. We discuss the presentation and outcomes of three patients with hemorrhagic VS as well as review the literature for this phenomenon. Consecutive adult patients with a histologically proven diagnosis of VS over a 9-year period were retrospectively reviewed. Fifty adult patients were identified with three (6%) having clinically significant intratumoral hemorrhage. This was defined as patients having acute to subacute symptoms with frank radiological evidence of hemorrhage. The mean age of diagnosis was 62 ± 9 years and the male-to female ratio was 2:1. The mean duration of symptoms, namely headache, vertigo, and sensorineural hearing impairment, was 26 ± 4 days with one patient presenting with acute coma. Retrosigmoid craniotomy for tumor resection was performed for all patients. Histopathological examination revealed extensive areas of microhemorrhage with considerable macrophage infiltration. All three patients were discharged with no additional neurological deficit and good functional performance. Clinically significant hemorrhagic VSs are rare, and patients may present with acute to subacute (i.e., within a month) symptoms of hearing loss headache, facial, or trigeminal nerve palsy. Macrophage infiltration is frequently encountered in tumor specimens and reflects the pivotal role of chronic inflammation in their pathophysiology. Surgical resection can lead to good outcomes with timely intervention.

Key-words:

Acoustic neuroma - intratumoral hemorrhage - vestibular schwannoma

Financial support and sponsorship

Nil.




Publication History

Received: 10 June 2020

Accepted: 29 July 2020

Article published online:
16 August 2022

© 2021. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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