"When the Benign Bleed" Vestibular Schwannomas with Clinically Significant Intratumoral Hemorrhage: A Case Series and Review of the Literature.

Autor: Woo PY; Department of Neurosurgery, Kwong Wah Hospital, Yau Ma Tei, Hong Kong., Lam PL; Diagnostic and Interventional Radiology, Kwong Wah Hospital, Yau Ma Tei, Hong Kong., Ip YH; Department of Neurosurgery, Kwong Wah Hospital, Yau Ma Tei, Hong Kong., Chan TS; Anatomical Pathology, Kwong Wah Hospital, Yau Ma Tei, Hong Kong., Ng OK; Anatomical Pathology, Kwong Wah Hospital, Yau Ma Tei, Hong Kong., Kwan MC; Department of Neurosurgery, Kwong Wah Hospital, Yau Ma Tei, Hong Kong., Wong HT; Department of Neurosurgery, Kwong Wah Hospital, Yau Ma Tei, Hong Kong., Wong AK; Department of Neurosurgery, Kwong Wah Hospital, Yau Ma Tei, Hong Kong., Chan KY; Department of Neurosurgery, Kwong Wah Hospital, Yau Ma Tei, Hong Kong.
Jazyk: angličtina
Zdroj: Asian journal of neurosurgery [Asian J Neurosurg] 2021 Feb 23; Vol. 16 (1), pp. 221-227. Date of Electronic Publication: 2021 Feb 23 (Print Publication: 2021).
DOI: 10.4103/ajns.AJNS_287_20
Abstrakt: 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.
Competing Interests: There are no conflicts of interest.
(Copyright: © 2021 Asian Journal of Neurosurgery.)
Databáze: MEDLINE
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