Perioperative problems in patients with brainstem tumors and their influence on patient outcome.
OBJECTIVE
Patients with brainstem tumors have many associated systemic abnormalities and are prone to develop perioperative complications. We studied the problems associated with brainstem tumors and their influence on the postoperative neurological outcome.


METHODS
Retrospective review of records of patients who underwent surgery for brainstem tumors over a period of 8 years was done. Preoperative variables, perioperative complications and neurological outcome as assessed by Glasgow Outcome Scale at the time of hospital discharge were noted. Association between perioperative factors and the unfavorable neurological outcome was evaluated.


RESULTS
Data of 70 patients were retrieved, 7 patients were excluded from the study because of incomplete data and data analysis was carried out for 63 patients. We found that lower cranial nerve palsies (32%) and hydrocephalus (43%) were common preoperatively. Various intraoperative problems encountered were hemodynamic instability (56%), major blood loss requiring blood transfusion (40%) and venous air embolism (11%), and postoperative problems were meningitis (51%), hypokalemia (38%), chest infection (21%), seizure (11%), deterioration of Glasgow Coma Scale (GCS, 11%), hyponatremia (8%), hydrocephalus (6%), respiratory distress (3%) and operatives site hematoma (3%). Fifty-six (89%) patients had favorable outcome at hospital discharge whereas, 7 (11%) had an unfavorable outcome. There was no association between pre- and intra-operative factors and the neurological outcome. Deterioration of GCS, chest infection, and the need for reintubation and tracheostomy were associated with unfavorable neurological outcome.


CONCLUSIONS
Patients of brainstem tumors are at increased risk of perioperative complications. Some of the postoperative complications were associated with unfavorable neurological outcome.
Department of Anaesthesia, Pain and Palliative Care, Dr. BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
Sachidanand J
SJ
Bharati
Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India.
Mihir Prakash
MP
Pandia
Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India.
Girija Prasad
GP
Rath
Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India.
Parmod Kumar
PK
Bithal
Department of Anaesthesia, Fortis Memorial Research Institute, Gurgaon, Haryana, India.
Hari Hara
HH
Dash
Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India.
Surya K
SK
Dube
Brainstem tumor; intraoperative complications; neurological outcome; postoperative complications