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Published on: February 29, 2020
Intracochlear hemorrhage after gamma knife radiosurgery
Valérie Franco-Vidal1, Murat Songu, Harold Blanchet
1Otolaryngology and Skull Base Surgery Department, University of Bordeaux, France.
Summary
Gamma Knife radiosurgery for vestibular schwannoma in a neurofibromatosis type 2 patient caused acute intracochlear hemorrhage. This rare complication led to hearing loss and facial paralysis, highlighting potential risks.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Audiology
Background:
- Vestibular schwannoma (VS) management often involves stereotactic radiosurgery.
- Neurofibromatosis type 2 (NF2) patients present with bilateral VS, posing complex treatment challenges.
- Gamma Knife stereotactic radiosurgery (GKRS) aims to control tumor growth while preserving neurological function.
Observation:
- A 20-year-old NF2 patient with bilateral VS underwent GKRS for a left-sided tumor to preserve hearing.
- Within 24 hours post-GKRS, the patient developed vertigo, profound ipsilateral hearing loss, and facial paralysis.
- MRI revealed an acute intracochlear hemorrhage in the treated cochlea.
Findings:
- The intracochlear hemorrhage resulted in permanent hearing loss and temporary facial nerve dysfunction.
- The hemorrhage was not attributed to coagulation defects, trauma, or infection.
- This case represents the first reported instance of acute intracochlear hemorrhage following GKRS for VS.
Implications:
- GKRS for VS, particularly in NF2 patients, carries a risk of rare but severe cochlear complications.
- Understanding the potential mechanisms, such as thermal effects or vascular changes, is crucial for risk mitigation.
- Further research is needed to refine GKRS protocols and improve patient outcomes in NF2-associated VS.
