Sudden Onset Hemorrhagic Transformation of Post-Radiation Vestibular Schwannoma Presenting with Acute Facial Paralysis

We present a 51-year-old male with a history of partial vestibular schwannoma resection followed by stereotactic radiosurgery who developed sudden, complete left facial paralysis 11 years after initial treatment. Imaging revealed intratumoral hemorrhage, and he underwent gross total resection. Pathology confirmed schwannoma with hemorrhage and radiation-induced vasculopathy without malignancy. This case demonstrates the potential for very late intratumoral hemorrhage following stereotactic radiosurgery for vestibular schwannoma and underscores the critical role of long-term surveillance in the management of this population. Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany