Intratumoral Hemorrhage in Vestibular Schwannomas After Stereotactic Radiosurgery: Multi-Institutional Study

Author:

Bin-Alamer Othman1ORCID,Abou-Al-Shaar Hussam1ORCID,Mallela Arka N.1,Kallos Justiss A.1,Deng Hansen1,Nabeel Ahmed M.23,Reda Wael A.24,Tawadros Sameh R.24,Abdelkarim Khaled25,El-Shehaby Amr M. N.24,Emad Reem M.26,Peker Selcuk7,Samanci Yavuz7,Lee Cheng-chia89,Yang Huai-che89,Mathieu David10,Tripathi Manjul11,Mantziaris Georgios12,Mullapudi Abhishek12,Urgosik Dusan13,Liscak Roman13,Bowden Greg N.14,Zaki Peter15,Wegner Rodney E.16,Shepard Matthew J.15,Sheehan Jason P.12,Niranjan Ajay1,Hadjipanayis Constantinos G.1,Lunsford L. Dade1

Affiliation:

1. Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA;

2. Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt;

3. Neurosurgery Department, Benha University, Qalubya, Egypt;

4. Neurosurgery Department, Ain Shams University, Cairo, Egypt;

5. Clinical Oncology Department, Ain Shams University, Cairo, Egypt;

6. Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt;

7. Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey;

8. Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan;

9. School of Medicine, National Yang-Ming University, Taipei, Taiwan;

10. Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada;

11. Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India;

12. Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA;

13. Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic;

14. Department of Neurosurgery, University of Alberta, Edmonton, Canada;

15. Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania, USA;

16. Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Allegheny Health Network, Pittsburgh, Pennsylvania, USA

Abstract

BACKGROUND AND OBJECTIVES: Intratumoral hemorrhage (ITH) in vestibular schwannoma (VS) after stereotactic radiosurgery (SRS) is exceedingly rare. The aim of this study was to define its incidence and describe its management and outcomes in this subset of patients. METHODS: A retrospective multi-institutional study was conducted, screening 9565 patients with VS managed with SRS at 10 centers affiliated with the International Radiosurgery Research Foundation. RESULTS: A total of 25 patients developed ITH (cumulative incidence of 0.26%) after SRS management, with a median ITH size of 1.2 cm3. Most of the patients had Koos grade II-IV VS, and the median age was 62 years. After ITH development, 21 patients were observed, 2 had urgent surgical intervention, and 2 were initially observed and had late resection because of delayed hemorrhagic expansion and/or clinical deterioration. The histopathology of the resected tumors showed typical, benign VS histology without sclerosis, along with chronic inflammatory cells and multiple fragments of hemorrhage. At the last follow-up, 17 patients improved and 8 remained clinically stable. CONCLUSION: ITH after SRS for VS is extremely rare but has various clinical manifestations and severity. The management paradigm should be individualized based on patient-specific factors, rapidity of clinical and/or radiographic progression, ITH expansion, and overall patient condition.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Neurology (clinical),Surgery

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