Thromboembolic phenomena in neurosurgical patients operated upon for primary and metastatic brain tumours

Abstract

A retrospective study was designed to evaluate clinical thromboembolic phenomena (TEP) in patients operated upon for brain tumours. Among 492 patients treated surgically in the supratentorial area, the overall incidence of clinical TEP was 7%. There were 5% with deep vein thrombosis (DVT) and 4% with clinical pulmonary embolism (PE). Seven patients (1%) died from massive PE. Among 141 patients treated surgically in the infratentorial area there were no episodes of TEP. Significant risk factors for TEP development were operations in the supratentorial area, malignant gliomas (compared to meningiomas) and para- or hemiparesis. Age, sex and the specific location in the supratentorial area were not found to be statistically significant risk factors. Among 12 patients who presented initially with DVT two developed PE despite full heparinization. 7/19 patients with PE died within minutes to hours of the clinical episode despite full conservative measures. In 2/26 patients who were treated with full heparinization complications occurred. There was one case of diffuse subcutaneous bleeding and one case of tumour bed haematoma. The identification of risk factors for the development of TEP will allow the implementation of prophylactic measures in appropriate patients undergoing elective brain tumour surgery.

Adjuvant enoxaparin therapy may decrease the incidence of postoperative thrombotic events though does not increase the incidence of postoperative intracranial hemorrhage in patients with meningiomas

“…It is thought that thromboembolic events that occur postoperatively following resection may be due to the tumor-induced hemostatic changes resulting in a hypercoagulable state and may be exacerbated by the post-surgical recovery period when patients are initially non-ambulatory. Because of this, patients with brain tumors, including meningiomas are at increased risk of developing deep vein thrombosis (DVT) and experiencing venous thromboembolic events (VTE) [6][7][8][9]. DVT and VTEs significantly increase tumor patient morbidity and mortality and therefore are important aspects of tumor treatment to address.…”

Retrospective analysis of 449 intracranial meningioma patients operated between years 2007 – 2013 in a single institute

“…VTE is still a risk for patients who underwent intracranial meningioma surgery and clinical incidences range up to 32% (1,6,9,12,20,21,26,28,34). In our series, 4.6% of patients experienced VTE and 5 patients died because of pulmonary embolism.…”

“…In the literature, there is a female predominance in adulthood meningiomas and a variable ratio of WHO grade II meningiomas (4,8,17,18,23,29,33,46). There is a known relatively high risk of postoperative venous thromboembolism (VTE) (1,6,9,12,20,21,26,28,34). Also there are large series investigating the relationship between age, sex, pathological subtype and location (8,18,42,46,49).…”

A Prospective Randomized Controlled Study of the Role of Heparin in Preventing Deep Venous Thrombosis in Postoperative Craniotomy Patients

“…The risk is especially high in those having resection of brain tumors, especially malignant tumors. 2,5 Prophylaxis with anticoagulant agents in neurosurgical patients has not gained wide acceptance because of concern about intracranial bleeding. On the other end of the spectrum is the risk of pulmonary embolism in neurosurgical patients which has been reported to be as high as 5%, with a mortality rate ranging from 9 to 50%.…”