Intratumoral Hemorrhage in Vestibular Schwannomas after Stereotactic Radiosurgery: Multi-Institutional Study

Othman Bin-Alamer; Arka N. Mallela; Justiss A. Kallos; Hansen Deng; Ahmed M. Nabeel; Wael A. Reda; Sameh R. Tawadros; Khaled Abdelkarim; Amr M.N. El-Shehaby; 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; L. Dade Lunsford; Hussam Abou-Al-Shaar

doi:10.1227/neu.0000000000002627

Intratumoral Hemorrhage in Vestibular Schwannomas after Stereotactic Radiosurgery: Multi-Institutional Study

Othman Bin-Alamer, Arka N. Mallela, Justiss A. Kallos, Hansen Deng, Ahmed M. Nabeel, Wael A. Reda, Sameh R. Tawadros, Khaled Abdelkarim, Amr M.N. El-Shehaby, Reem M. Emad, Selcuk Peker, Yavuz Samanci, Cheng Chia Lee, Huai Che Yang, David Mathieu, Manjul Tripathi, Georgios Mantziaris, Abhishek Mullapudi, Dusan Urgosik, Roman LiscakGreg N. Bowden, Peter Zaki, Rodney E. Wegner, Matthew J. Shepard, Jason P. Sheehan, Ajay Niranjan, Constantinos G. Hadjipanayis, L. Dade Lunsford, Hussam Abou-Al-Shaar

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND AND OBJECTIVES: Intratumoral 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. METHODS: A retrospective multi-institutional study was conducted, screening 9565 patients with VS managed with SRS at 10 centers affiliated with the International Radiosurgery Research Foundation. RESULTS: A 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. CONCLUSION: ITH 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.

Original language	English
Pages (from-to)	289-296
Number of pages	8
Journal	Neurosurgery
Volume	94
Issue number	2
DOIs	https://doi.org/10.1227/neu.0000000000002627
State	Published - 1 Feb 2024
Externally published	Yes

Keywords

Complication
Gamma Knife
Intratumoral hemorrhage
Stereotactic radiosurgery
Vestibular schwannoma

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10.1227/neu.0000000000002627

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Bin-Alamer, O., Mallela, A. N., Kallos, J. A., Deng, H., Nabeel, A. M., Reda, W. A., Tawadros, S. R., Abdelkarim, K., El-Shehaby, A. M. N., Emad, R. M., Peker, S., Samanci, Y., Lee, C. C., Yang, H. C., Mathieu, D., Tripathi, M., Mantziaris, G., Mullapudi, A., Urgosik, D., ... Abou-Al-Shaar, H. (2024). Intratumoral Hemorrhage in Vestibular Schwannomas after Stereotactic Radiosurgery: Multi-Institutional Study. Neurosurgery, 94(2), 289-296. https://doi.org/10.1227/neu.0000000000002627

@article{e8411711a5704fa39e8510c781682055,

title = "Intratumoral Hemorrhage in Vestibular Schwannomas after Stereotactic Radiosurgery: Multi-Institutional Study",

abstract = "BACKGROUND AND OBJECTIVES: Intratumoral 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. METHODS: A retrospective multi-institutional study was conducted, screening 9565 patients with VS managed with SRS at 10 centers affiliated with the International Radiosurgery Research Foundation. RESULTS: A 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. CONCLUSION: ITH 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.",

keywords = "Complication, Gamma Knife, Intratumoral hemorrhage, Stereotactic radiosurgery, Vestibular schwannoma",

author = "Othman Bin-Alamer and Mallela, {Arka N.} and Kallos, {Justiss A.} and Hansen Deng and Nabeel, {Ahmed M.} and Reda, {Wael A.} and Tawadros, {Sameh R.} and Khaled Abdelkarim and El-Shehaby, {Amr M.N.} and Emad, {Reem M.} and Selcuk Peker and Yavuz Samanci and Lee, {Cheng Chia} and Yang, {Huai Che} and David Mathieu and Manjul Tripathi and Georgios Mantziaris and Abhishek Mullapudi and Dusan Urgosik and Roman Liscak and Bowden, {Greg N.} and Peter Zaki and Wegner, {Rodney E.} and Shepard, {Matthew J.} and Sheehan, {Jason P.} and Ajay Niranjan and Hadjipanayis, {Constantinos G.} and Lunsford, {L. Dade} and Hussam Abou-Al-Shaar",

note = "Publisher Copyright: Copyright {\textcopyright} 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Congress of Neurological Surgeons.",

year = "2024",

month = feb,

day = "1",

doi = "10.1227/neu.0000000000002627",

language = "English",

volume = "94",

pages = "289--296",

journal = "Neurosurgery",

issn = "0148-396X",

publisher = "Wolters Kluwer Medknow Publications",

number = "2",

}

Bin-Alamer, O, Mallela, AN, Kallos, JA, Deng, H, Nabeel, AM, Reda, WA, Tawadros, SR, Abdelkarim, K, El-Shehaby, AMN, Emad, RM, Peker, S, Samanci, Y, Lee, CC, Yang, HC, Mathieu, D, Tripathi, M, Mantziaris, G, Mullapudi, A, Urgosik, D, Liscak, R, Bowden, GN, Zaki, P, Wegner, RE, Shepard, MJ, Sheehan, JP, Niranjan, A, Hadjipanayis, CG, Lunsford, LD & Abou-Al-Shaar, H 2024, 'Intratumoral Hemorrhage in Vestibular Schwannomas after Stereotactic Radiosurgery: Multi-Institutional Study', Neurosurgery, vol. 94, no. 2, pp. 289-296. https://doi.org/10.1227/neu.0000000000002627

TY - JOUR

T1 - Intratumoral Hemorrhage in Vestibular Schwannomas after Stereotactic Radiosurgery

T2 - Multi-Institutional Study

AU - Bin-Alamer, Othman

AU - Mallela, Arka N.

AU - Kallos, Justiss A.

AU - Deng, Hansen

AU - Nabeel, Ahmed M.

AU - Reda, Wael A.

AU - Tawadros, Sameh R.

AU - Abdelkarim, Khaled

AU - El-Shehaby, Amr M.N.

AU - Emad, Reem M.

AU - Peker, Selcuk

AU - Samanci, Yavuz

AU - Lee, Cheng Chia

AU - Yang, Huai Che

AU - Mathieu, David

AU - Tripathi, Manjul

AU - Mantziaris, Georgios

AU - Mullapudi, Abhishek

AU - Urgosik, Dusan

AU - Liscak, Roman

AU - Bowden, Greg N.

AU - Zaki, Peter

AU - Wegner, Rodney E.

AU - Shepard, Matthew J.

AU - Sheehan, Jason P.

AU - Niranjan, Ajay

AU - Hadjipanayis, Constantinos G.

AU - Lunsford, L. Dade

AU - Abou-Al-Shaar, Hussam

PY - 2024/2/1

Y1 - 2024/2/1

N2 - BACKGROUND AND OBJECTIVES: Intratumoral 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. METHODS: A retrospective multi-institutional study was conducted, screening 9565 patients with VS managed with SRS at 10 centers affiliated with the International Radiosurgery Research Foundation. RESULTS: A 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. CONCLUSION: ITH 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.

AB - BACKGROUND AND OBJECTIVES: Intratumoral 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. METHODS: A retrospective multi-institutional study was conducted, screening 9565 patients with VS managed with SRS at 10 centers affiliated with the International Radiosurgery Research Foundation. RESULTS: A 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. CONCLUSION: ITH 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.

KW - Complication

KW - Gamma Knife

KW - Intratumoral hemorrhage

KW - Stereotactic radiosurgery

KW - Vestibular schwannoma

UR - http://www.scopus.com/inward/record.url?scp=85182728012&partnerID=8YFLogxK

U2 - 10.1227/neu.0000000000002627

DO - 10.1227/neu.0000000000002627

M3 - Article

C2 - 37581440

AN - SCOPUS:85182728012

SN - 0148-396X

VL - 94

SP - 289

EP - 296

JO - Neurosurgery

JF - Neurosurgery

IS - 2

ER -

Intratumoral Hemorrhage in Vestibular Schwannomas after Stereotactic Radiosurgery: Multi-Institutional Study

Abstract

Keywords

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