术后立体定向放疗（SRS）后耳蜗神经瘤（VS）内出血（ITH）极其罕见。本研究的目的是确定其发病率，并描述该患者亚群的治疗和预后。本回顾性多机构研究在国际放射外科研究基金会附属的10个中心对9565例接受SRS治疗的VS患者进行了筛查。共有25名患者在SRS治疗后出现ITH（累计发生率为0.26%），ITH的中位数大小为1.2立方厘米。大多数患者具有Koos II-IV级VS，中位年龄为62岁。ITH发生后，21名患者接受了观察，2名患者进行了紧急手术干预，2名患者最初进行观察，因延迟性出血扩展和/或临床恶化而进行了晚期切除。被切除肿瘤的组织病理学显示出典型的良性VS组织学，没有硬化，但有慢性炎症细胞和多个出血片段。最后随访时，17名患者病情好转，8名患者病情稳定。VS术后ITH极其罕见，但具有不同的临床表现和严重性。治疗范式应根据患者特定因素、临床和/或影像学进展的快慢、ITH扩展和患者整体状况进行个体化决策。版权©2023年神经外科医生大会。保留所有权利。

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.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.A total of 25 patients developed ITH (cumulative incidence of 0.26%) after SRS management, with a median ITH size of 1.2 cm3. 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.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.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.