title: Clinically significant intratumoral hemorrhage in patients with vestibular schwannoma.
abstract: The frequency of intratumoral hemorrhage (ITH) in vestibular schwannoma (VS) remains undefined.
  
  
  
  Retrospective case series of all patients diagnosed with hemorrhagic VS between 2003 and 2015 at a single tertiary academic skull base center.
  
  
  
  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.
  
  
  
  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.
  
  
  
  4. Laryngoscope, 127:1420-1426, 2017.
authors: Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.|Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.
authors: Matthew L
authors: ML
authors: Carlson
authors: Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.
authors: Nicole M
authors: NM
authors: Tombers
authors: Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.|Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.
authors: Colin L W
authors: CLW
authors: Driscoll
authors: Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.|Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.
authors: Jamie J
authors: JJ
authors: Van Gompel
authors: Department of Radiology, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.
authors: John I
authors: JI
authors: Lane
authors: Department of Pathology and Laboratory Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.
authors: Aditya
authors: A
authors: Raghunathan
authors: Department of Neurology, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.
authors: Kelly D
authors: KD
authors: Flemming
authors: Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.|Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, U.S.A.
authors: Michael J
authors: MJ
authors: Link
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005158:Facial Paralysis / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000209:etiology / Q000601:surgery; D034381:Hearing Loss / Q000209:etiology / Q000601:surgery; D006470:Hemorrhage / Q000209:etiology* / Q000601:surgery; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000150:complications*; D012189:Retrospective Studies
keywords: Vestibular schwannoma; acoustic neuroma; anticoagulation; hemorrhage; intratumoral hemorrhage; microsurgery; skull base surgery; subarachnoid hemorrhage; warfarin