ORIGINAL ARTICLE - BRAIN TUMORS Tumor-associated hemorrhage in patients with vestibular schwannoma Xiang Yang 1 & Jiagang Liu 1 & Yuekang Zhang 1 & Seidu A. Richard 1 Received: 14 April 2018 /Accepted: 7 June 2018 # Springer-Verlag GmbH Austria, part of Springer Nature 2018 Abstract Object Intratumoral hemorrhage (ITH) associated with vestibular schwannomas (VS) is very rare. We retrospectively analyzed VS patients presenting with ITH in our department to further gain a better understanding of this uncommon clinical presentation. Methods We treated seven patients who had VS presenting with ITH between January 2012 and June 2017. All the patients had preoperative computed tomography (CT), computed tomography angiography (CTA), and magnetic resonance imaging(MRI) done which aided in the radiological diagnosis as well as postoperative MRI to confirm the resection extent of the VS. Continuous electrophysiological monitoring of cranial nerves was carried out during surgery. Results Of the seven patients, three were male and four were female. Their ages ranged from 42 to 71 years (average age, 57.4 years). Two patients reported a history of hypertension. Sudden onset or rapid worsening of clinical symptoms occurred in five patients at time of hemorrhage. The mean diameter of the lesions was 4.1 cm (range, 3.0–5.0 cm). No patient had a pretreatment of stereotactic radiosurgery. Gross total resection was achieved in four cases and subtotal resection in three cases. There were no surgery-related neurological deficits but one patient died 18 days after surgery. Follow-up visits were scheduled at 6 months postoperatively and two patients had tumor recurrence and received stereotactic radiosurgery again. Conclusions The incidence of ITH in VS is relatively rare and hypertension may highly correlate with ITH in VS. In comparison with peritumoral adhesion caused by chronic inflammation in multicystic VS with microhemorrhage,ITH caused by acute massive hemorrhage will not increase the extent of peritumoral adhesion immediately. The prognosis of surgery for patients with acute hemorrhagic VS may be better than that for microhemorrhage in multicystic VS. Besides, timely microsurgical treatment is also important to relieve symptoms. Keywords Intratumoral hemorrhage (ITH) . Vestibular schwannomas (VS) . Hypertension . Peritumoral adhesion Introduction Vestibular schwannomas (VS) are benign tumors of cranial nerve (CN) VIII that originate from Schwann cells. A minority of cases are associated with type II neurofibromatosis. VS represent 5–8% of all intracranial tumors [6] and approximate- ly 80% of cerebellopontine angle (CPA) tumors [14]. These tumors have various clinical presentations including hearing loss, tinnitus, gait ataxia, and vertigo in most cases, and less common symptoms like trigeminal neuralgia and facial hypoesthesia, as well as dysphagia in large tumors [9]. Intratumoral hemorrhage (ITH) occurs in 11% of all brain tumors, commonly involving malignant gliomas, metastatic tumors, and pituitary adenomas, but this occurrence is very rare in VS [13]. The first case of ITH in VS was reported by McCoyd et al. in 1974 [10], and to date about 55 cases have been reported in literature [3, 12]. We present seven unusual cases of VS with ITH. We also discuss the possible mecha- nisms and predisposing factors as well as the clinical charac- teristics that foster a better understanding of the behavior of these tumors to provide the best individualized treatment options. Clinical material and methods Data obtained from seven patients with hemorrhagic VS be- tween January 2012 and June 2017 was summarized in This article is part of the Topical Collection on Brain Tumours * Yuekang Zhang yangxiangcool2017@163.com 1 Department of Neurosurgery, West China Hospital of Sichuan University, No.37, Guoxue Alley, Chengdu 610041, Sichuan Province, People’ s Republic of China Acta Neurochirurgica https://doi.org/10.1007/s00701-018-3588-7