A Prospective Analysis of Complications of Intracranial Tumor Surgery

Abstract

Aims There is a recent trend toward delivering neurosurgical care in large supraregional centers with intradepartmental subspecialization. We report a 14-year prospective audit of a single surgeon's experience of intracranial tumor surgery with an emphasis on complications.

Methods A total of 616 procedures were performed on 596 patients of which 321 were male and 275 were female (age range: 1–84 years). Tumors were categorized as glioma, meningioma, metastasis, and other. Complications were recorded as infection, intracranial hematoma, neurologic deterioration, and death.

Results Of the 305 patients who underwent glioma surgery, 4 (1.3%) developed a hematoma, 4 (1.3%) had neurologic deterioration, 5 (1.6%) died within 30 days of surgery, and 1 (0.33%) had an infection. Of the 120 patients who underwent surgery for meningioma, 8 (6.6%) developed an infection, 1 (0.83%) developed a hematoma, and 7 (5.8%) had neurologic deterioration. Of the 59 patients who underwent surgery for brain metastasis, 1 (1.7%) had neurologic deterioration. Of the remaining patients, 4 (3.0%) developed infection and 6 (4.5%) had neurologic deterioration.

Conclusions The overall complication rate was infection, 2.1%; hematoma, 0.8%; neurologic deterioration, 2.9%; and death, 0.8%. These results compare favorably with published series.

Keywords

brain tumor - craniotomy - craniotomy complications - centralization

• References

• 1 Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008; 36 (5) 309-332
• 2 Delgado-López PD, Martín-Velasco V, Castilla-Díez JM, Galacho-Harriero AM, Rodríguez-Salazar A. Preservation of bone flap after craniotomy infection. Neurocirugia (Astur) 2009; 20 (2) 124-131
• 3 Korinek AM, Golmard JL, Elcheick A , et al. Risk factors for neurosurgical site infections after craniotomy: a critical reappraisal of antibiotic prophylaxis on 4,578 patients. Br J Neurosurg 2005; 19 (2) 155-162
• 4 Lassen B, Helseth E, Rønning P , et al. Surgical mortality at 30 days and complications leading to recraniotomy in 2630 consecutive craniotomies for intracranial tumors. Neurosurgery 2011; 68 (5) 1259-1268 ; discussion 1268–1269
• 5 Dashti SR, Baharvahdat H, Spetzler RF , et al. Operative intracranial infection following craniotomy. Neurosurg Focus 2008; 24 (6) E10
• 6 Seifman MA, Lewis PM, Rosenfeld JV, Hwang PY. Postoperative intracranial haemorrhage: a review. Neurosurg Rev 2011; 34 (4) 393-407
• 7 Taylor WA, Thomas NW, Wellings JA, Bell BA. Timing of postoperative intracranial hematoma development and implications for the best use of neurosurgical intensive care. J Neurosurg 1995; 82 (1) 48-50
• 8 Palmer JD, Sparrow OC, Iannotti F. Postoperative hematoma: a 5-year survey and identification of avoidable risk factors. Neurosurgery 1994; 35 (6) 1061-1064 ; discussion 1064–1065
• 9 Cabantog AM, Bernstein M. Complications of first craniotomy for intra-axial brain tumour. Can J Neurol Sci 1994; 21 (3) 213-218
• 10 Sawaya R, Hammoud M, Schoppa D , et al. Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors. Neurosurgery 1998; 42 (5) 1044-1055 ; discussion 1055–1056
• 11 Bernstein M, Parrent AG. Complications of CT-guided stereotactic biopsy of intra-axial brain lesions. J Neurosurg 1994; 81 (2) 165-168
• 12 Nishihara M, Sasayama T, Kudo H, Kohmura E. Morbidity of stereotactic biopsy for intracranial lesions. Kobe J Med Sci 2011; 56 (4) E148-E153
• 13 Morokoff AP, Zauberman J, Black PM. Surgery for convexity meningiomas. Neurosurgery 2008; 63 (3) 427-433 ; discussion 433–434
• 14 Curry WT, McDermott MW, Carter BS, Barker II FG. Craniotomy for meningioma in the United States between 1988 and 2000: decreasing rate of mortality and the effect of provider caseload. J Neurosurg 2005; 102 (6) 977-986
• 15 Mezue WC, Ohaegbulam SC, Ndubuisi CA, Chikani MC, Achebe DS. Management of intracranial meningiomas in Enugu, Nigeria. Surg Neurol Int 2012; 3: 110
• 16 Seicean A, Seicean S, Schiltz NK , et al. Short-term outcomes of craniotomy for malignant brain tumors in the elderly. Cancer 2013; 119 (5) 1058-1064
• 17 Boviatsis EJ, Bouras TI, Kouyialis AT, Themistocleous MS, Sakas DE. Impact of age on complications and outcome in meningioma surgery. Surg Neurol 2007; 68 (4) 407-411 ; discussion 411
• 18 Chang SM, Parney IF, McDermott M , et al; Glioma Outcomes Investigators. Perioperative complications and neurological outcomes of first and second craniotomies among patients enrolled in the Glioma Outcome Project. J Neurosurg 2003; 98 (6) 1175-1181
• 19 Long DM, Gordon T, Bowman H , et al. Outcome and cost of craniotomy performed to treat tumors in regional academic referral centers. Neurosurgery 2003; 52 (5) 1056-1063 ; discussion 1063–1065
• 20 Cowan Jr JA, Dimick JB, Leveque JC, Thompson BG, Upchurch Jr GR, Hoff JT. The impact of provider volume on mortality after intracranial tumor resection. Neurosurgery 2003; 52 (1) 48-53 ; discussion 53–54
• 21 Smith ER, Butler WE, Barker II FG. Craniotomy for resection of pediatric brain tumors in the United States, 1988 to 2000: effects of provider caseloads and progressive centralization and specialization of care. Neurosurgery 2004; 54 (3) 553-563 ; discussion 563–565
• 22 The Society of British Neurological Surgeons. Neurosurgical national audit programme. Available at: https://www.hed.nhs.uk/sbns
• 23 National Office of Clinical Audit. NOCA works with multidisciplinary stakeholders. Available at: http://www.noca.ie/audits
• 24 National Health Service United Kingdom. Consultant outcome data. Available at: https://www.nhs.uk/Service-Search/performance/Consultants