Almahariq Fadi, Budimir Krunoslav, Kastelancic Andelo, Lakic Marin, Oreskovic Darko, Blazevic Andrea, Chaurasia Bipin
Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia.
School of Medicine, University of Zagreb, Zagreb, Croatia.
Ann Med Surg (Lond). 2025 Jan 9;87(1):355-359. doi: 10.1097/MS9.0000000000002772. eCollection 2025 Jan.
Vestibular schwannomas (VSs) are benign tumors of cranial nerve VIII, comprising 8% of primary intracranial neoplasms. Hemorrhagic VSs, though rare, present unique clinical challenges due to their potential for rapid neurological decline.
We present a case of a 68-year-old male with sudden severe headache, nausea, vomiting, and balance issues, initially diagnosed with a hematoma at the right cerebellopontine angle until an magnetic resonance imaging (MRI) scan verified a bleeding schwannoma. Due to deteriorating neurological status and signs of obstructive hydrocephalus on computed tomography (CT), urgent neurosurgical neuromonitoring, successfully managed the hemorrhagic VS, with postoperative recovery intervention required. Neurosurgical treatment, guided by intraoperative outcomes, restoring normal life. Urgent transfer to a medical center with a neurosurgical showing favorable outcomes.
Cerebellopontine hematoma verified by CT mandates MRI to exclude tumorous bleeding, which is crucial in cases lacking prior MRI.
Though rare, hemorrhagic VS must be considered in neurologically decompensated patients, especially with risk factors. Timely surgical intervention, despite precipitating a comatose state, can yield satisfactory results.
前庭神经鞘瘤（VSs）是颅神经VIII的良性肿瘤，占原发性颅内肿瘤的8%。出血性VSs虽然罕见，但因其可能导致快速神经功能衰退而带来独特的临床挑战。
我们报告一例68岁男性，突发严重头痛、恶心、呕吐及平衡问题，最初被诊断为右侧小脑脑桥角血肿，直到磁共振成像（MRI）扫描证实为出血性神经鞘瘤。由于神经状态恶化及计算机断层扫描（CT）显示梗阻性脑积水迹象，紧急进行神经外科神经监测，成功治疗了出血性VS，术后需要恢复干预。神经外科治疗以术中结果为指导，恢复了正常生活。紧急转至有神经外科且预后良好的医疗中心。
CT证实的小脑脑桥角血肿需行MRI以排除肿瘤性出血，这在既往无MRI检查的病例中至关重要。
尽管出血性VS罕见，但在神经功能失代偿的患者中，尤其是有危险因素的患者，必须考虑到这种情况。及时的手术干预尽管可能导致昏迷状态，但仍可取得满意结果。
