Acute Intratumoral Bleeding in a Cystic Vestibular Schwannoma: Case Report

Introduction: Vestibular schwannomas are slow-growing tumors with progressive hearing and vestibular symptoms as the usual presentation. Cystic degeneration in schwannomas are found not so rarely, and it is probably secondary to microhemorrhages inside the tumor. We report a very unusual case of vestibular schwannoma with a massive hemorrhage inside the tumor and abrupt clinical presentation.

Methods: We reviewed the cases of vestibular schwannomas treated by the authors with particular attention to their presentation symptoms and the occurrence of associated cysts.

Results: We report a case of a 52-year-old female with acute presentation symptoms of intracranial hypertension and compression of the brain stem due to a large cystic vestibular schwannoma with massive bleeding inside the cyst. Total removal of the tumor was obtained through a suboccipital retrosigmoidal approach after the drainage of the hemorrhagic collection inside the tumor. Pathological studies confirmed hemosiderin deposition in the walls of the cyst.

Conclusions: We report the CT and MR imaging appearance and the operative findings of a very rare case of massive intratumoral bleeding in a vestibular schwanoma. This unusual and unpredictable occurrence would be considered as an additional risk in the cases treated conservatively or with gamma-knife.