Key Clinical Findings & Highlights
- Focuses on emergency management of giant cerebellopontine angle tumor apoplexy.
- Demonstrates complete retrosigmoid microsurgical resection with facial nerve anatomical preservation.
- Reverses life-threatening brainstem compression and acute obstructive hydrocephalus.
Abstract
Introduction & Background
Hemorrhagic transformation in acoustic neuromas occurs in less than 0.5% of cases. When acute bleeding expands a giant tumor (>4 cm), acute fourth ventricle effacement leads to obstructive hydrocephalus and herniation.
Clinical Case Presentation & Diagnosis
A 41-year-old male with long-standing mild hearing loss developed sudden explosive headache, persistent vomiting, ataxia, and progressive stupor within 24 hours. Cranial CT and contrast MRI demonstrated a 4.8 cm heterogeneously enhancing left CPA mass with acute hyperdense intratumoral hematoma, severe brainstem deviation, and acute triventricular hydrocephalus.
Surgical Technique & Management
An emergency external ventricular drain (EVD) was placed followed immediately by a retrosigmoid suboccipital craniectomy. Under operative microscope magnification and continuous facial nerve (CN VII) electromyographic monitoring, internal tumor debulking and hematoma evacuation were completed, achieving gross total tumor resection with anatomic facial nerve preservation.
Discussion & Literature Context
Pathological vascular fragility, intrinsic microaneurysm formation, and rapid tumor enlargement contribute to spontaneous intratumoral apoplexy. Prompt microsurgical decompression restores brainstem perfusion and prevents permanent neurological disability.
Conclusion
Emergency retrosigmoid craniectomy with facial nerve monitoring is life-saving and yields excellent long-term functional recovery.
How to Cite This Research
N. Nayak, A. K. Sharma, Dr. Surendra K. Gupta, P. R. Singh (2022). "Acute presentation of giant sporadic vestibular schwannoma with massive hemorrhage: A critical review with a case illustration". Brain and Spine, Volume 2, Article 100897.
