Hemorrhagic Risk in Vestibular Schwannoma Surgeries: Insights and Implications

BACKGROUND Vestibular schwannoma is a slow-growing benign tumor arising from the 8th cranial nerve. It can originate in the cerebellopontine angle (CPA). This retrospective study aimed to investigate the factors associated with outcomes following surgical resection of vestibular schwannoma in the CPA in 30 patients at a single center in Turkey, focusing on postoperative intratumoral hemorrhage. MATERIAL AND METHODS Thirty patients (mean age 42.8 years, range 17-81) underwent vestibular schwannoma surgery via a lateral suboccipital retrosigmoid approach. Patients were categorized as 'less bleeding' (n=15) or 'more bleeding' (n=15) based on the intraoperative nature of the tumor. Demographic characteristics, tumor size, extent of resection, postoperative intratumor bleeding rates, morbidity, and mortality were evaluated. RESULTS Mean tumor size was significantly larger in highly hemorrhagic tumors (3.8 cm, range 2.1-5 cm) compared with less hemorrhagic tumors (2.1 cm, range 1.8-3 cm) (P<0.001). Total resection was achieved in 60% of patients with highly hemorrhagic tumors >3 cm and chronic diseases, compared with 80% in less hemorrhagic tumors (P=0.02). Postoperative intratumoral hemorrhage occurred in 83.3% of subtotal resections in highly hemorrhagic tumors, versus 6.7% in less hemorrhagic tumors (P<0.001). CONCLUSIONS Larger vestibular schwannoma size is associated with increased hemorrhagic nature, complicating total resection. Subtotal resection in hemorrhagic tumors significantly increases the risk of postoperative bleeding and edema. When possible, total removal should be attempted to minimize complications. In cases requiring subtotal excision, careful postoperative management of coagulation and blood pressure is crucial.