Turkish Neurosurgery
The First Reported Case of a Hemorrhagic Solitary Fibrous Tumor at the Cerebellopontine Angle Successfully Managed with Multimodal Therapy
I-Chiao Tsai1, Pei-Yu Chen2, Hung-Lin Lin1
1China Medical University Hospital, China Medical University, Taichung City, Taiwan, Department of Neurosurgery, Taichung City, Taiwan,
2China Medical University Hospital, China Medical University, Taichung City, Taiwan, Department of Pathology, Taichung City, Taiwan,
DOI: 10.5137/1019-5149.JTN.49979-25.2

Introduction: Intracranial solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms, and cases of tumor bleeding are rarely seen. While radiographically similar to meningioma, SFTs exhibit a more aggressive clinical course. Surgical resection followed by adjuvant radiotherapy is the mainstay of treatment. We present the first case of a hemorrhagic SFT located at the cerebellopontine (CP) angle, which was successfully treated with multimodal therapy. Material and Methods: A 31-year-old man presented with a headache and altered consciousness. Neuroimaging revealed a large dural-based tumor at the left CP angle with subdural hematoma (SDH). Results: The patient underwent preoperative endovascular embolization and near-total surgical resection. Further histopathological analysis confirmed the diagnosis of intracranial SFT. The patient recovered favorably and underwent adjuvant gamma-knife stereotactic radiosurgery (SRS) for the residual tumor. Discussion: Intracranial SFTs are aggressive and highly vascular neoplasms. Clinical symptoms are mainly due to mass effect. Hemorrhagic cases are exceptionally uncommon, with only a few reported. Imaging often resembles meningioma but with features such as a narrow dural base, osteolysis, and absence of dural tail aid differentiation. Diagnosis is supported by nuclear expression of STAT6. Treatment includes surgical resection followed by adjuvant radiotherapy or SRS. Preoperative embolization offers additional benefit for bleeding control. Conclusion: To the best of our knowledge, this is the first reported case of a hemorrhagic SFT treated with a combination of preoperative endovascular embolization and adjuvant SRS. This case illustrates that tailored multimodal treatment is both effective and safe for managing hemorrhagic intracranial SFTs.

Corresponding author : Hung-Lin Lin