S Yugandhar, Rekapalli Rajasekhar, Lanka Vivek, Dasari Kavya, Edala Komala Sai Phanindra
Radiodiagnosis, All India Institute of Medical Sciences, Mangalagiri, IND.
Neurological Surgery, All India Institute of Medical Sciences, Mangalagiri, IND.
Cureus. 2025 Jul 31;17(7):e89119. doi: 10.7759/cureus.89119. eCollection 2025 Jul.
Greater superficial petrosal nerve (GSPN) schwannomas are exceptionally rare and have not been previously reported to present with acute hemorrhage. In contrast, hemorrhagic vestibular and trochlear schwannomas have been described, often presenting with abrupt neurological symptoms. We report a case of a 41-year-old woman who presented with a sudden-onset headache and vomiting. CT revealed a hyperdense extra-dural lesion in the right middle cranial fossa, arising from an enlarged GSPN hiatus, with a subdural hematoma along the tentorium and fronto-parieto-temporal convexity (maximum thickness: 5 mm). MRI demonstrated a 25 × 20 mm extra-axial mass with heterogeneous T2 signal and perilesional edema. CT angiography showed intense enhancement, and digital subtraction angiography revealed a robust tumor blush with active contrast extravasation from the petrous branch of the middle meningeal artery. Super-selective embolization using 150-250 μm polyvinyl alcohol (PVA) particles achieved complete devascularization. Histopathological confirmation was not obtained, as the patient opted for conservative management; diagnosis was based on characteristic imaging features and precise anatomical localization. Post-embolization, the patient's symptoms resolved, and she was discharged neurologically intact by day 7. She remained stable at the three-month follow-up without symptom recurrence. This case represents the first reported instance of a hemorrhagic GSPN schwannoma. It underscores the importance of considering rare bleeding neural tumors in acute headache presentations and demonstrates that trans-arterial embolization can offer immediate hemostasis and clinical stabilization, providing a critical window for safe transition to planned surgical excision. This strategy may serve as a valuable adjunct in the management of similar cases of other hypervascular cranial nerve tumors presenting with acute hemorrhage.
岩浅大神经（GSPN）神经鞘瘤极为罕见，此前尚无急性出血的报道。相比之下，出血性前庭和滑车神经鞘瘤已有描述，常表现为突发神经症状。我们报告一例41岁女性，突发头痛和呕吐。CT显示右侧中颅窝硬膜外高密度病变，起源于扩大的GSPN裂孔，沿小脑幕和额颞顶叶凸面有硬膜下血肿（最大厚度：5mm）。MRI显示一个25×20mm的轴外肿块，T2信号不均匀，周围有水肿。CT血管造影显示强化明显，数字减影血管造影显示肿瘤染色明显，有来自脑膜中动脉岩支的造影剂外渗。使用150 - 250μm聚乙烯醇（PVA）颗粒进行超选择性栓塞实现了完全去血管化。由于患者选择保守治疗，未获得组织病理学确诊；诊断基于特征性影像学表现和精确的解剖定位。栓塞后，患者症状缓解，第7天神经功能完好出院。三个月随访时病情稳定，无症状复发。该病例是首例报道的出血性GSPN神经鞘瘤。它强调了在急性头痛表现中考虑罕见出血性神经肿瘤的重要性，并表明经动脉栓塞可立即止血并实现临床稳定，为安全过渡到计划中的手术切除提供关键窗口期。该策略可能是治疗其他伴有急性出血的高血运性颅神经肿瘤类似病例的有价值辅助手段。
