Surgical strategies for hemorrhagic vestibular schwannoma with acute neurological decline: a case report with a literature review.

INTRODUCTION AND

IMPORTANCE

Vestibular schwannomas (VSs) are benign tumors of cranial nerve VIII, comprising 8% of primary intracranial neoplasms. Hemorrhagic VSs, though rare, present unique clinical challenges due to their potential for rapid neurological decline.

CASE PRESENTATION: We present a case of a 68-year-old male with sudden severe headache, nausea, vomiting, and balance issues, initially diagnosed with a hematoma at the right cerebellopontine angle until an magnetic resonance imaging (MRI) scan verified a bleeding schwannoma. Due to deteriorating neurological status and signs of obstructive hydrocephalus on computed tomography (CT), urgent neurosurgical neuromonitoring, successfully managed the hemorrhagic VS, with postoperative recovery intervention required. Neurosurgical treatment, guided by intraoperative outcomes, restoring normal life. Urgent transfer to a medical center with a neurosurgical showing favorable outcomes.

CLINICAL DISCUSSION: Cerebellopontine hematoma verified by CT mandates MRI to exclude tumorous bleeding, which is crucial in cases lacking prior MRI.

CONCLUSION

Though rare, hemorrhagic VS must be considered in neurologically decompensated patients, especially with risk factors. Timely surgical intervention, despite precipitating a comatose state, can yield satisfactory results.