Pulmonary Embolism as a Cause of Death in the Neurosurgical Patient

Wetzel, Nicholas; Anderson, Marion C.; Shields, Thomas W.

doi:10.3171/jns.1960.17.4.0664

Cited by 30 publications

(11 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…On these grounds we feel that this PE was not directly related to the surgery and immunotherapy administered during this study. Furthermore, this 5% (1/19) incidence of death due to pulmonary emboli in this is similar to the 3.4% death rate due to PE in patients undergoing intracranial surgery [29][30][31].…”

Section: Clinical Response Observed After Therapysupporting

confidence: 76%

Therapy of recurrent high grade gliomas with surgery, and autologous mitogen activated IL-2 stimulated killer (MAK) Lymphocytes: I. Enhancement of MAK lytic activity and cytokine production by PHA and clinical use of PHA

Jeffes

Beamer²,

Jacques³

et al. 1993

J Neuro-Oncol

View full text Add to dashboard Cite

Section: Clinical Response Observed After Therapysupporting

confidence: 76%

Therapy of recurrent high grade gliomas with surgery, and autologous mitogen activated IL-2 stimulated killer (MAK) Lymphocytes: I. Enhancement of MAK lytic activity and cytokine production by PHA and clinical use of PHA

Jeffes

Beamer²,

Jacques³

et al. 1993

J Neuro-Oncol

View full text Add to dashboard Cite

“…Wetzel et al reviewed a series of 6,065 neurosurgical patients [1] and found a 3% incidence of fatal postoperative pulmonary emboli; however, patients with brain tumors were not specifically identified [1]. In an autopsy study involving 334 patients with primary intracranial neoplasms, the incidence of venous thrombosis was 27.5%, statistically significantly different from the 17% incidence for a control neurosurgical group [2].…”

mentioning

confidence: 99%

Postoperative venous thromboembolism and brain tumors: part I. Clinical profile

et al. 1992

View full text Add to dashboard Cite

Forty-six patients who underwent surgery for brain tumors were studied prospectively with 125I labeled Fibrinogen leg scans to detect postoperative venous thrombosis. The incidence of thrombosis was 72% for meningioma patients, 60% for glioblastoma patients, and 20% for brain metastasis patients.Correlation between the occurrence of venous thrombosis and the various clinical factors thought to be responsible for the high incidence of thrombosis generally failed to show statistical significance. This finding, along with the marked variation in the incidence of venous thrombosis between the different brain tumor groups, strongly suggests that biological factors play a more important role than clinical factors in determining which brain tumor patient will suffer a postoperative thrombotic event.A direct association between malignancies and thromboembolic complications has been well established, but the occurrence of these complications in patients with brain tumors has not received sufficient attention. Wetzel et al. reviewed a series of 6,065 neurosurgical patients [1] and found a 3% incidence of fatal postoperative pulmonary emboli; however, patients with brain tumors were not specifically identified [1]. In an autopsy study involving 334 patients with primary intracranial neoplasms, the incidence of venous thrombosis was 27.5%, statistically significantly different from the 17% incidence for a control neurosurgical group [2]. Several clinical studies have confirmed a high incidence of postoperative thrombophlebitis in neurosurgical patients [3][4][5][6][7][8][9], but brain tumor patients have rarely been studied separately.In another study, Ruff & Posner reported [10] that of 268 consecutive patients with malignant glioma, 36% developed clinical signs of systemic venous thrombosis. Choucair et al. [11], in their series of 715 patients, identified a 4% risk of venous thromboembolism after 6 weeks of the craniotomy. In none of these studies were the patients evaluated prospectively.We undertook this study with the hope of specifically identifying clinical risk factors and reliably estimating the incidence of postoperative clots detectable by 125I-labeled fibrinogen scans in patients with the three most common brain tumors [12,13]. Materials and methodsForty-six male patients operated on for glioblastoma, meningioma, or brain metastasis at the V.A.M.C. in Cincinnati were included in this study. Clinical data obtained preoperatively included patient age, side of the lesion, duration of symptoms, Karnofsky score, ambulatory status, and the presence of paresis.

show abstract

“…EUROSURGICAL patients are often at risk for the development of deep vein thrombosis (DVT) of the lower extremity and/or pulmonary embolism (PE) due to prolonged surgery, immobilization, paralysis, advanced age, and malignancy. 7'23 Deep vein thrombosis is reported to occur in 29% to 43% of neurosurgical patients) 4'25 While the incidence of PE has not recently been analyzed in neurosurgical patients, Wetzel, et al, 28 have implicated this event in 3% of neurosurgical deaths.…”

mentioning

confidence: 99%

Management of symptomatic deep venous thrombosis and pulmonary embolism on a neurosurgical service

Swann¹,

Black²,

Baker³

1986

Journal of Neurosurgery

View full text Add to dashboard Cite

The authors present a retrospective analysis of the management of deep vein thrombosis (DVT) and pulmonary embolism (PE) in neurosurgical patients at the Massachusetts General Hospital from January, 1978, through June, 1982. There were 44 cases of DVT and 13 cases of PE. Management modalities included observation only, femoral vein ligation, inferior vena cava clipping, transvenous placement of an inferior vena cava filter or umbrella, and anticoagulation therapy. Six (75%) of eight patients with symptomatic DVT who were managed by observation alone had subsequent pulmonary emboli, and three (38%) died. Femoral vein ligation was followed by PE in one of four cases and led to significant leg swelling in two others. Neither observation alone nor femoral vein ligation can be recommended as routine management options. Partial inferior vena cava interruption with a De Weese clip, Kim-Ray Greenfield filter, or Mobin-Uddin umbrella all successfully prevented pulmonary emboli. The major problem associated with these methods was leg edema, which occurred in 47% of patients with clip placement, 25% with filter placement, and 21% with a Mobin-Uddin umbrella. Anticoagulation therapy was associated with a complication rate of 29% and a mortality rate of 15%. Fatal PE and paradoxical hypercoagulability with gangrene of a lower extremity were the causes of death. In one patient, hemorrhage into a glioblastoma occurred following discontinuation of anticoagulation therapy when the coagulation parameters were normal. The authors conclude that: 1) management with observation alone of patients with symptomatic DVT places the patient at risk for the development of life-threatening pulmonary emboli; 2) the safety and timing of therapeutic anticoagulation in postoperative neurosurgical patients or patients with tumors is unclear; and 3) partial interruption of the inferior vena cava with a transvenous filter successfully prevents PE and may represent a safer alternative to anticoagulation therapy.

show abstract

Pulmonary Embolism as a Cause of Death in the Neurosurgical Patient

Cited by 30 publications

References 4 publications

Therapy of recurrent high grade gliomas with surgery, and autologous mitogen activated IL-2 stimulated killer (MAK) Lymphocytes: I. Enhancement of MAK lytic activity and cytokine production by PHA and clinical use of PHA

Therapy of recurrent high grade gliomas with surgery, and autologous mitogen activated IL-2 stimulated killer (MAK) Lymphocytes: I. Enhancement of MAK lytic activity and cytokine production by PHA and clinical use of PHA

Postoperative venous thromboembolism and brain tumors: part I. Clinical profile

Management of symptomatic deep venous thrombosis and pulmonary embolism on a neurosurgical service

Contact Info

Product

Resources

About