Postoperative intracranial haemorrhage: a review.
Postoperative haemorrhage (POH) is one of the most serious complications of any cranial neurosurgical procedure and is associated with significant morbidity and mortality. The relative paucity of work investigating this postoperative complication prompted us to undertake a review of the literature, focussing on demographic, clinical, and surgical risk factors. A literature search was undertaken using Ovid MEDLINE (1950-2009) using keywords including craniectomy, craniotomy, neurosurgery, intracranial, reoperation, repeat craniotomy, postoperative, haemorrhage, haematoma, and bleeding. The rates of POH following intracranial procedures reported in the literature vary greatly, and meaningful comparison is difficult. We defined postoperative haemorrhage as that following craniotomy, which is clinically significant and requires surgical evacuation. Risk factors include pre-existing medical comorbidities including hypertension, coagulopathies and haematological abnormalities, intraoperative hypertension and blood loss, certain lesion pathologies including tumours, chronic subdural haematomas, and deficiencies in haemostasis. We conclude by providing recommendations for clinical practice based on the literature reviewed to aid clinicians in the detection and avoidance of POH.
Department of Neurosurgery, The Alfred Hospital, Commercial Road, Melbourne, VIC, 3004, Australia.
Marc A
MA
Seifman
Phillip M
PM
Lewis
Jeffrey V
JV
Rosenfeld
Peter Y K
PY
Hwang
D000328:Adult; D000368:Aged; D000925:Anticoagulants; D050197:Atherosclerosis / Q000150:complications; D016063:Blood Loss, Surgical; D001927:Brain Diseases / Q000473:pathology / Q000601:surgery; D016657:Cerebral Amyloid Angiopathy / Q000150:complications; D048909:Diabetes Complications / Q000453:epidemiology; D005260:Female; D006487:Hemostasis; D006801:Humans; D006973:Hypertension / Q000150:complications; D020300:Intracranial Hemorrhages / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D010976:Platelet Count; D019106:Postoperative Hemorrhage / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D012307:Risk Factors
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
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