Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
World Neurosurg. 2014 Nov;82(5):751-6. doi: 10.1016/j.wneu.2013.02.069. Epub 2013 Feb 27.
Clinically significant intratumoral hemorrhage historically has been reported in only a small fraction of vestibular schwannomas (VS). Patients with hemorrhagic VS are more likely to present with neurologic deficits and have worse outcomes than patients with nonhemorrhagic VS. The purpose of this study is to analyze characteristics that may predispose VS to hemorrhage and that may prove helpful in the management and treatment of VS.
A literature search was conducted using National Library of Medicine and National Institutes of Health databases to identify articles pertaining to intratumoral hemorrhage in VS. The authors selected 39 cases, described in 18 published articles, to review.
Average patient age and tumor size in hemorrhagic cases of VS did not differ significantly from nonhemorrhagic cases of VS. Facial nerve dysfunction at presentation occurred with greater frequency in cases of hemorrhagic VS (33.3%) than in nonhemorrhagic VS (6.0%). Death occurred much more frequently in cases of hemorrhagic VS (10.0%) than in nonhemorrhagic VS (0.2%). Abnormality of tumor-associated vasculature was noted histologically in many cases, and a large number of the cases reported prior treatment by stereotactic radiosurgery.
Understanding the origins and clinical implications of intratumoral hemorrhage in VS could potentially assist in clinical decision making and patient counseling.
临床上，仅小部分前庭神经鞘瘤（VS）会出现有临床意义的肿瘤内出血。与非出血性 VS 患者相比，出血性 VS 患者更有可能出现神经功能缺损，且预后更差。本研究旨在分析可能导致 VS 出血的特征，这些特征可能有助于 VS 的治疗管理。
通过美国国立卫生研究院和美国国立图书馆医学数据库进行文献检索，以确定与 VS 肿瘤内出血相关的文章。作者选择了 18 篇已发表文章中描述的 39 例病例进行综述。
VS 出血病例的平均患者年龄和肿瘤大小与非出血病例无显著差异。VS 出血病例的面神经功能障碍发生率（33.3%）高于非出血病例（6.0%）。VS 出血病例的死亡率（10.0%）显著高于非出血病例（0.2%）。许多病例的组织学显示肿瘤相关血管异常，且大量病例报告了立体定向放射外科治疗史。
了解 VS 肿瘤内出血的起源和临床意义可能有助于临床决策和患者咨询。
