Intratumoral hemorrhage in jugular foramen schwannoma after stereotactic radiosurgery: A case report

Abstract

Background: Clinically significant intratumoral hemorrhage is a rare complication of stereotactic radiosurgery (SRS) for benign tumors. Case Description: Here, we present the case of a 64-year-old man who underwent SRS for a relatively large dumbbell-shaped left jugular foramen schwannoma (JFS) and thereafter developed intratumoral hemorrhage. On post-SRS day 3, he developed lower cranial nerve palsies with radiographically evident tumor expansion. His neurological conditions had gradually improved thereafter; however, he suddenly developed headache, dizziness, and mild hearing deterioration at 7 months due to intratumoral hemorrhage. We managed the patient conservatively, and eventually, his symptoms improved except for slight ataxia and hearing deterioration. Follow-up images at 4 years from SRS demonstrated significant tumor shrinkage. This is the first report describing intratumoral hemorrhage after SRS for JFS. Conclusion: Transient expansion of the tumor and subsequent venous stasis around the tumor may have played a role in the hemorrhage. Intratumoral hemorrhage should be considered as a rare, but potential complication of SRS for JFSs.

Two Cases of Rare Intratumoral Hemorrhage Following COVID-19 Vaccination

“…In case 1, intratumoral hemorrhage of a vestibular schwannoma, which was stable for eight years after SRS, occurred on the day after vaccination. Intratumoral hemorrhage in vestibular schwannomas is rare, with a reported incidence of 0.4% in general [ 3 ] and 0.26% after SRS [ 4 ]. It usually occurs 80 or 130 months after SRS [ 4 , 5 ].…”

“…Intratumoral hemorrhage in vestibular schwannomas is rare, with a reported incidence of 0.4% in general [ 3 ] and 0.26% after SRS [ 4 ]. It usually occurs 80 or 130 months after SRS [ 4 , 5 ]. Although the mechanism of intratumoral hemorrhage and the effects of the radiation are not completely understood, anticoagulation has been cited as a risk factor for intratumoral hemorrhage in vestibular schwannomas [ 3 ].…”

“…In addition, similar to myocarditis after vaccination, acute inflammation with predominantly lymphocytic infiltration was observed pathologically [ 8 , 9 ]. Kawashima et al have reported that microhemorrhage or thrombosis due to vascular endothelial damage is likely to cause intratumoral hemorrhage [ 4 ].…”