The role of extended coagulation screening in adult cranial neurosurgery

Arthur Wagner; Maria Wostrack; Frederik Hartz; Johannes Heim; Erik Hameister; Martin Hildebrandt; Bernhard Meyer; Christof Winter

doi:10.1016/j.bas.2023.101756

The role of extended coagulation screening in adult cranial neurosurgery

Brain Spine. 2023 May 11:3:101756. doi: 10.1016/j.bas.2023.101756. eCollection 2023.

Authors

Arthur Wagner¹, Maria Wostrack¹, Frederik Hartz¹, Johannes Heim¹, Erik Hameister², Martin Hildebrandt², Bernhard Meyer¹, Christof Winter²

Affiliations

¹ Department of Neurosurgery, Technical University Munich School of Medicine, Munich, Germany.
² Institute of Clinical Chemistry and Pathobiochemistry, Technical University Munich School of Medicine, Munich, Germany.

Abstract

Introduction: Postoperative hemorrhage after adult cranial neurosurgery is a serious complication with substantial morbidity and mortality.

Research question: We investigated if an extended preoperative screening and an early treatment of previously undetected coagulopathies may decrease the risk of postoperative hemorrhage.

Methods: A prospective study cohort of patients undergoing elective cranial surgery and receiving the extended coagulatory work-up were compared to a propensity matched historical control cohort. The extended work-up included a standardized questionnaire on the patient's bleeding history as well as coagulatory tests of Factor XIII, von-Willebrand-Factor and PFA-100®. Deficiencies were substituted perioperatively. The primary outcome was determined as the surgical revision rate due to postoperative hemorrhage.

Results: The study cohort and the control cohort included 197 cases each, without any significant difference in the preoperative intake of anticoagulant medication (p = .546). Most common interventions were resections of malignant tumors (41%), benign tumors (27%) and neurovascular surgeries (9%) in both cohorts. Imaging revealed postoperative hemorrhage in 7 cases (3.6%) in the study cohort and 18 cases (9.1%) in the control cohort (p = .023). Of these, revision surgeries were significantly more common in the control cohort with 14 cases (9.1%) compared to 5 cases (2.5%) in the study cohort (p = .034). Differences in mean intraoperative blood loss were not significant with 528 ml in the study cohort and 486 ml in the control cohort (p = .376).

Conclusion: Preoperative extended coagulatory screening may allow for revealing previously undiagnosed coagulopathies with subsequent preoperative substitution and thereby reduction of risk for postoperative hemorrhage in adult cranial neurosurgery.

Keywords: Coagulation substitution; Complication; Cranial surgery; Extended coagulation; Postoperative hemorrhage.