PMC8202378_01
Patient 1. Computed tomography scan showing left cerebellopontine angle lesion hemorrhage (a). T1-weighted magnetic resonance imaging revealed a widened internal acoustic meatus and intratumoral hyperintense signal changes (white arrowheads) suggestive of hemorrhagic vestibular schwannomas compressing the brainstem (b, axial; c, coronal). The corresponding areas are isointense (gray arrowhead) on T2W imaging indicating subacute (6-9 days) methemaglobin blood (d). Contrast-enhanced T1-weighted scan demonstrated heterogeneous enhancement with widening of the internal acoustic meatus indicative of a multicystic vestibular schwannoma(e). Susceptibility-weighted imaging revealed diffuse hypointense signal changes reflecting blood product deposition (f)
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F1
A CT scan and a subsequent MRI scan revealed a 3.7 cm x 3.1 cm x 3.5 cm left heterogeneous gadolinium-contrast enhancing hemorrhagic multicystic CP angle tumor with intratumoral fluid levels [Figure 1].
PMC8202378_02
Patient 2. Computed tomography scan revealing acute intratumoral hemorrhage at right cerebellopontine angle causing brainstem compression (a) and acute obstructive hydrocephalus (b). The widened IAM is suggestive of vestibular schwannomas (a, white arrow). One-month postoperative contrast-enhanced T1-weighted magnetic resonance imaging showing residual tumor extending into the IAM (c). Patient 3. Computed tomography scan showing a left cerebellopontine angle hemorrhagic tumor (d). Contrast-enhanced T1-weighted magnetic resonance imaging revealing a widened IAM and heterogenous enhancement (e). SWI depicting intratumoral blood product deposition (f)
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F2
The lesion was heterogeneously contrast-enhancing and was causing brainstem compression with obstructive hydrocephalus [Figure 2d-f].
Intraoperative photographs of Patient 2. A vascular cerebellopontine angle tumor with prominent arterial feeders was encountered (a). The intratumoral blood clot was evacuated (b). Histopathology revealed a vestibular schwannoma with infiltrating macrophages within both Antoni A and Antoni B regions (c, gray arrows, H and E, x50). Tumor arterial occlusion is noted in the right lower corner of the microphotograph. Patient 3's vestibular schwannoma revealed extensive microhemorrhage within the Antoni B regions. Infiltrating macrophages are identified at the border with Antoni B regions (d, white arrows, H and E, x10)
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F3
The histological diagnosis was VS with several focal areas of microhemorrhage, hemosiderin deposits, and tumor-infiltrating macrophages [Figure 3d].
PMC8202378_03
Patient 2. Computed tomography scan revealing acute intratumoral hemorrhage at right cerebellopontine angle causing brainstem compression (a) and acute obstructive hydrocephalus (b). The widened IAM is suggestive of vestibular schwannomas (a, white arrow). One-month postoperative contrast-enhanced T1-weighted magnetic resonance imaging showing residual tumor extending into the IAM (c). Patient 3. Computed tomography scan showing a left cerebellopontine angle hemorrhagic tumor (d). Contrast-enhanced T1-weighted magnetic resonance imaging revealing a widened IAM and heterogenous enhancement (e). SWI depicting intratumoral blood product deposition (f)
AJNS-16-221-g002.jpg
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F2
The lesion was heterogeneously contrast-enhancing and was causing brainstem compression with obstructive hydrocephalus [Figure 2d-f].
Intraoperative photographs of Patient 2. A vascular cerebellopontine angle tumor with prominent arterial feeders was encountered (a). The intratumoral blood clot was evacuated (b). Histopathology revealed a vestibular schwannoma with infiltrating macrophages within both Antoni A and Antoni B regions (c, gray arrows, H and E, x50). Tumor arterial occlusion is noted in the right lower corner of the microphotograph. Patient 3's vestibular schwannoma revealed extensive microhemorrhage within the Antoni B regions. Infiltrating macrophages are identified at the border with Antoni B regions (d, white arrows, H and E, x10)
AJNS-16-221-g003.jpg
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F3
The histological diagnosis was VS with several focal areas of microhemorrhage, hemosiderin deposits, and tumor-infiltrating macrophages [Figure 3d].