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
