• Othman Bin-Alamer, Hussam Abou-Al-Shaar, Arka N Mallela, Justiss A Kallos, Hansen Deng, Ahmed M Nabeel, Wael A Reda, Sameh R Tawadros, Khaled Abdelkarim, El-ShehabyAmr M NAMNGamma Knife Center Cairo, Nasser Institute Hospital, Cairo , Egypt.Neurosurgery Department, Ain Shams University, Cairo , Egypt., Reem M Emad, Selcuk Peker, Yavuz Samanci, Cheng-Chia Lee, Huai-Che Yang, David Mathieu, Manjul Tripathi, Georgios Mantziaris, Abhishek Mullapudi, Dusan Urgosik, Roman Liscak, Greg N Bowden, Peter Zaki, Rodney E Wegner, Matthew J Shepard, Jason P Sheehan, Ajay Niranjan, Constantinos G Hadjipanayis, and L Dade Lunsford.
• Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA.
• Neurosurgery. 2024 Feb 1; 94 (2): 289296289-296.

Background And ObjectivesIntratumoral 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.MethodsA retrospective multi-institutional study was conducted, screening 9565 patients with VS managed with SRS at 10 centers affiliated with the International Radiosurgery Research Foundation.ResultsA total of 25 patients developed ITH (cumulative incidence of 0.26%) after SRS management, with a median ITH size of 1.2 cm 3 . 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.ConclusionITH 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.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

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