title: Chronic recurrent subarachnoid hemorrhage from a trigeminal nerve malignant peripheral nerve sheath tumor: case report.
abstract: OBJECTIVE
  Clinically significant intratumoral or peritumoral bleeding from trigeminal nerve tumors is very rare.
  
  
  METHODS
  We report the case of a 59-year-old man who presented with recurrent subarachnoid hemorrhage from a left trigeminal nerve malignant peripheral nerve sheath tumor. He presented with decreased consciousness, left facial hypesthesia, and left facial weakness. Trigeminal neuralgia was present for 18 months. Cranial computed tomographic and magnetic resonance imaging scans revealed a left parapontine mass with cystic changes and intratumoral bleeding. Furthermore, signs of hemosiderosis of the subarachnoid space were noted. Lumbar puncture revealed fresh bleeding. Angiography detected no aneurysm or other causes of bleeding. The patient became fully alert within hours, the facial weakness improved within a few days. There was no evidence of vasospasm or persisting hydrocephalus. He underwent left-sided suboccipital craniotomy for macroscopically total tumor removal.
  
  
  METHODS
  The patient underwent total tumor removal via a left suboccipital approach. Intraoperatively, evidence of recurrent intratumoral bleeding was noted. Histological examination revealed a malignant peripheral nerve sheath tumor (World Health Organization Grade III). Postoperatively, the hypesthesia improved significantly. The patient was transferred to radiotherapy for external beam radiation.
  
  
  CONCLUSIONS
  This is the first report regarding a malignant peripheral nerve sheath tumor of the trigeminal nerve that caused clinically significant subarachnoid hemorrhage caused by intratumoral bleeding.
authors.affiliation: Department of Neurosurgery, Schleswig-Holstein University Medical Center, Kiel Campus, Kiel, Germany. starka@nch.uni-kiel.de
authors.forename: Andreas M
authors.initials: AM
authors.lastname: Stark
authors.forename: Ralf
authors.initials: R
authors.lastname: Buhl
authors.forename: Heinz-Herrmann
authors.initials: HH
authors.lastname: Hugo
authors.forename: Thorsten
authors.initials: T
authors.lastname: Straube
authors.forename: H Maximilian
authors.initials: HM
authors.lastname: Mehdorn
mesh_terms: D002908:Chronic Disease; D003244:Consciousness Disorders / Q000209:etiology / Q000503:physiopathology; D003390:Cranial Nerve Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D003399:Craniotomy; D019299:Decompression, Surgical; D005155:Facial Nerve Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018317:Nerve Sheath Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D011878:Radiotherapy; D012008:Recurrence; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D013346:Subarachnoid Space / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014276:Trigeminal Nerve / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D020433:Trigeminal Nerve Diseases / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D014277:Trigeminal Neuralgia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology