Acute Hemorrhage into Schwannomas of the Cerebellopontine Angle is an Uncommon, Life-Threatening Complication of Large Tumors

Abstract

Objective: Hemorrhage into tumors has well been described in head and neck tumors. With regard to the cerebellopontine angle (CPA), this is a rarer entity. Because of its localization, however, it can be linked to severe complications. Study Design: We present two cases of known lateral skull base schwannomas that represented with acute deterioration in their condition. Management and prognosis are presented. Patients: These cases involved a 68-year-old woman with a 47 × 34 × 47 mm vestibular schwannoma (VS) with expansion of the internal acoustic meatus and no hydrocephalus. The second case was of a 64-year-old lady with a 34×40× 68mm bulbar nerve schwannoma expanding the jugular foramen also with no evidence of hydrocephalus. The patient with the bulbar schwannoma was managed conservatively due to the lack of cranial nerve palsies and symptoms and her reluctance for surgery. The patient with the vestibular schwannoma was awaiting surgery after a period of observation as the patient was initially reluctant for surgery. Both patients deteriorated suddenly and rapidly. CT showed hemorrhage into the tumors. Debulking of the vestibular schwannoma via the retrosigmoid approach was achieved while hemorrhage in the second case was fatal. Conclusion: Hemorrhage into large CPA schwannomas is rare but can be catastrophic. This should, however, be considered when patients with known large skull base schwannomas suddenly deteriorate. Urgent diagnostic imaging is indicated.