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  • Risk Factors for Post-operative Hemorrhage Following Intracranial Meningioma Resection

    Final Number:
    1612

    Authors:
    Neel Shailendra Joshi; Ramin Lalezari; Peter Sylvester MD; Ananth Kesav Vellimana MBBS; Michael R. Chicoine MD; Albert H. Kim MD, PhD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Post-operative intracranial hemorrhage (POH) is a known complication of cranial meningioma resection. Despite this, there are limited data regarding predictive risk factors for POH in these cases. This study aims to identify clinically significant risk factors for POH after resection of intracranial meningiomas.

    Methods: A retrospective review of 604 consecutive intracranial meningioma patients who underwent surgical resection at a tertiary care center was performed. POH was defined as post-operative blood measuring >1 cm maximal thickness on post-operative CT scan. Symptomatic POH was defined as hemorrhage associated with new focal neurological deficit or otherwise unexplained change in mental status. Potential risk factors were analyzed by univariate and multivariate logistic regression.

    Results: Among 604 patients with intracranial meningiomas, 15.6% experienced POH. Symptomatic POH was observed in 6.6% patients, with 2.3% of patients requiring surgical intervention. On univariate analysis, risk factors for POH included increased age, decreased peri-operative platelet count, increased tumor volume, residual tumor, elevated perioperative mean arterial pressure (MAP), significant tumor vascularity, vein sacrifice, and use of intra-operative lumbar drain. On multivariate analysis, increased tumor volume, residual tumor, and use of lumbar drain were significant risk factors for POH. For symptomatic POH, univariate risk factors included increased tumor volume, elevated peri-operative MAP, significant tumor vascularity, and use of lumbar drain; multivariate risk factors included use of lumbar drain and significant tumor vascularity. Decreased peri-operative platelet count, increased tumor volume, and high peri-operative MAP were significant risk factors for POH requiring surgery in univariate analysis.

    Conclusions: Both modifiable and non-modifiable risk factors were found to predict POH. These data support a practice of careful peri-operative monitoring when operating on large meningiomas, especially in the setting of a lumbar drain. Although operations for POH were uncommon, close attention to perioperative platelet count and MAP may be warranted.

    Patient Care: This research highlights modifiable and non-modifiable factors to consider in determining a patient's risk of post-operative hemorrhage following intracranial meningioma resection.

    Learning Objectives: 1) Identify independent prognostic factors for post-operative hemorrhage following meningioma resection; 2) Determine clinically significant recommendations for improved workup and management of meningioma patients to minimize risk of hemorrhage

    References: 1 Gerlach R, Raabe A, Scharrer I, Meixensberger J, Seifer V. Post-operative hematoma after surgery for intracranial meningiomas: Causes, avoidable risk factors and clinical outcome. Neurol Res 2004; 26: 61-66. 2 Lee B, Hong S, Chu W, Kang J. Risk Factors of Postoperative Hematomas after Surgery for Intracranial Meningiomas. J Korean Neurosurg Soc 2006; 39: 109-113. 3 Kalfas I, Little J. Postoperative Hemorrhage: A Survey of 4992 Intracranial Procedures. Neurosurgery 1998; 23: 343-347

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