Intratumoral hemorrhage in vestibular schwannomas post-radiosurgery: a systematic review

BACKGROUND: Vestibular schwannomas (VS) are benign tumors affecting the vestibulocochlear nerve. They cause symptoms like hearing loss and vertigo. Treatment options include surgery and stereotactic radiosurgery (SRS). However, SRS can lead to rare complications like intratumoral hemorrhage (ITH). This review aims to explore ITH post-SRS, including its incidence and risk factors, to improve patient care. METHODS: This systematic review, conducted in accordance with PRISMA 2020 guidelines, examines intratumoral hemorrhage (ITH) post-radiosurgery for vestibular schwannomas. Searches encompassed PubMed, Google Scholar, the Cochrane Library, Embase, Web of Science, and Scopus up to January 2024. Inclusion criteria required documented vestibular schwannoma with confirmed ITH occurring after SRS. Data extraction involved study and participant characteristics, with discrepancies resolved by discussion. Given clinical and methodological heterogeneity, quantitative pooling was not performed; results are presented as a qualitative narrative synthesis. RESULTS: Eleven studies comprising 47 patients met inclusion criteria. Patients ranged from 25 to 79 years of age, with clustering in the sixth decade. A subset of patients had identifiable bleeding risk factors, most commonly hypertension and anticoagulant use. Symptom profiles were heterogeneous; trigeminal neuropathy and disequilibrium were the most frequently reported presentations. Management ranged from observation to surgical resection. On descriptive analysis, approximately half of patients demonstrated outcomes classified as favorable by the reporting authors; mortality was reported in 2 of 47 patients (4.35%). These figures must be interpreted with caution given the small total sample, predominance of case reports, and absence of standardized outcome definitions across included studies. CONCLUSION: In conclusion, managing intratumoral hemorrhage following radiosurgery for vestibular schwannomas remains a complex clinical challenge. This review highlights varied patient outcomes, emphasizing the importance of personalized treatment approaches. Tailoring treatment decisions to individual factors such as tumor characteristics and patient preferences is crucial for optimizing outcomes and minimizing complications, underscoring the need for close collaboration among specialists in clinical practice. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42024511320.