Miki Shunichiro, Ishikawa Eiichi, Yamamoto Tetsuya, Akutsu Hiroyoshi, Matsuda Masahide, Sakamoto Noriaki, Matsumura Akira
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 2-1-1 Tennodai, Tsukuba, Ibaraki 305-8576, Japan.
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 2-1-1 Tennodai, Tsukuba, Ibaraki 305-8576, Japan.
J Clin Neurosci. 2015 Jul;22(7):1196-9. doi: 10.1016/j.jocn.2014.12.019. Epub 2015 Mar 31.
A 48-year-old man with right hemi-facial palsy and cerebellar ataxia was referred to our hospital. Three years and 10 months earlier he had undergone gamma knife radiosurgery (GKRS) at the referring hospital for an 18 mm right vestibular schwannoma. Slight tumor enlargement had been observed on MRI performed at the referring hospital 3 years after the GKRS. On close follow-up after another 6 months an MRI showed an obvious enlargement of the tumor. An MRI on admission revealed an iso-intense mass lesion measuring 36 mm in maximum diameter at the right cerebellopontine angle. A two stage surgery was conducted using a retrosigmoid approach because bleeding from the tumor wall was difficult to control intraoperatively during the first operation. At the second operation, the majority of the tumor capsule had converted to necrotic tissue. A large hematoma cavity was present inside the tumor capsule which explained the rapid increase in size over a short period of time. Near total removal was achieved. Histopathological examination revealed massive intratumoral hemorrhage within a typical vestibular schwannoma with no malignancy. The complication of intratumoral hemorrhage is very rare and the utility of stereotactic radiation surgery/therapy, including GKRS, for vestibular schwannoma is well known. However, we must emphasize that careful follow-up is still required, even after several years.
一名48岁男性，患有右侧面瘫和小脑共济失调，被转诊至我院。三年零十个月前，他因右侧18mm前庭神经鞘瘤在转诊医院接受了伽玛刀放射外科手术（GKRS）。GKRS术后3年，转诊医院的MRI检查发现肿瘤略有增大。在随后6个月的密切随访中，MRI显示肿瘤明显增大。入院时的MRI显示，右侧桥小脑角有一个最大直径为36mm的等密度肿块病变。由于第一次手术中肿瘤壁出血难以控制，因此采用乙状窦后入路进行了两阶段手术。在第二次手术中，大部分肿瘤包膜已转化为坏死组织。肿瘤包膜内有一个大血肿腔，这解释了肿瘤在短时间内迅速增大的原因。实现了近全切除。组织病理学检查显示，典型的前庭神经鞘瘤内有大量肿瘤内出血，无恶性肿瘤。肿瘤内出血的并发症非常罕见，立体定向放射手术/治疗（包括GKRS）在前庭神经鞘瘤中的应用是众所周知的。然而，我们必须强调，即使在数年之后，仍需要仔细随访。
