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Clinically significant intratumoral hemorrhage in patients with vestibular schwannoma
Author(s) -
Carlson Matthew L.,
Tombers Nicole M.,
Driscoll Colin L. W.,
Van Gompel Jamie J.,
Lane John I.,
Raghunathan Aditya,
Flemming Kelly D.,
Link Michael J.
Publication year - 2017
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.26193
Subject(s) - medicine , schwannoma , surgery , perioperative , paresis , retrospective cohort study
Objectives The frequency of intratumoral hemorrhage (ITH) in vestibular schwannoma (VS) remains undefined. Methods Retrospective case series of all patients diagnosed with hemorrhagic VS between 2003 and 2015 at a single tertiary academic skull base center. Results Five patients with ITH were evaluated, representing 0.4% of all newly diagnosed VS evaluated at the authors' center during this time. The median age at time of diagnosis was 66 years (range 39–83), four of five cases occurred in men, and all had sporadic unilateral tumors. The frequency of ITH among patients receiving anticoagulation was 5.6% (2 of 36), compared to only 0.2% (3 of 1356) in non‐anticoagulated patients ( P = 0.006), representing a 25‐fold increase. At time of hemorrhage, all patients had acute onset of headache, disequilibrium, and progression of hearing loss; three reported trigeminal symptoms, and two exhibited acute moderate facial paresis. The median tumor size at diagnosis of hemorrhage was 3.1 cm (range 2.4–4.2 cm), and three patients had radiological evidence of hydrocephalus. All patients underwent microsurgical resection. There were no perioperative deaths. At a median follow‐up of 25 months (3–70 months), no patient has experienced tumor recurrence. Conclusion Tumor‐associated hemorrhage in VS occurs in 0.4% of cases and commonly presents with acute neurological change. The risk of clinically significant hemorrhage is greater in patients receiving anticoagulation compared to the general VS population. Prompt microsurgical resection should be pursued when possible since tumor removal may improve neurological symptoms, relieve brainstem compression, and reduce the risk of repeat hemorrhage. Level of Evidence 4. Laryngoscope , 127:1420–1426, 2017