title: Delayed post-operative haemorrhage after carmustine wafer implantation: a case series from two UK centres.
abstract: OBJECTIVE
  Significant haemorrhage following intracranial tumour resection may occur in 1-2% of cases and the majority occur within the first few hours post-operatively. Implantation of carmustine wafers has been associated with increased operative site complications in some series, but post-operative haematoma is not routinely reported. We analyzed the characteristics of post-operative haemorrhage after carmustine wafer insertion.
  
  
  METHODS
  We performed a retrospective audit of surgical site haematoma after tumour resection and insertion of carmustine wafers in two neurosurgical units in the UK (University Hospital of North Staffordshire, Stoke-on-Trent, March 2003 - July 2012; Wessex Neurological Centre, Southampton, October 2005 - January 2013).
  
  
  RESULTS
  During the specified time periods, carmustine wafers were inserted in 181 operations in 177 patients. We identified acute operative site haematomas after carmustine wafer insertion in 8 (4.4%) patients. All presented in a delayed fashion on or after Day 2 post-operatively. In contrast, acute operative site haematoma was present in 4/491 (0.81%) of patients who underwent resection without gliadel wafer insertion.
  
  
  CONCLUSIONS
  In contrast to the expected timing of bleeding following intracranial tumour resection, all carmustine wafer patients who experienced haemorrhage presented in a delayed fashion on or after Day 2 post-operatively. The causative factors for universally delayed post-operative haematoma after carmustine wafer insertion are unclear and further studies are required to characterize this phenomenon.
authors: Department of Neurosurgery, West Wing, John Radcliffe Hospital , Oxford , UK.
authors: Rahul Surendra
authors: RS
authors: Shah
authors: Bobak
authors: B
authors: Homapour
authors: Elizabeth
authors: E
authors: Casselden
authors: James Geoffrey
authors: JG
authors: Barr
authors: Paul L
authors: PL
authors: Grundy
authors: Howard L
authors: HL
authors: Brydon
mesh_terms: D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000009:adverse effects*; D001932:Brain Neoplasms / Q000601:surgery*; D002330:Carmustine / Q000008:administration & dosage / Q000009:adverse effects*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005909:Glioblastoma / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D006113:United Kingdom
chemical_list: D018906:Antineoplastic Agents, Alkylating; D002330:Carmustine
keywords: carmustine; craniotomy; gliadel; high-grade glioma; post-operative haemorrhage