Tactics of surgical treatment of patients with postoperative hemorrhagic complications in surgery of brain tumors

Background. Comparative analysis of approaches to the surgical treatment of postoperative hemorrhagic complications (POH) in brain tumor surgery is difficult due to the lack of a generally accepted definition of the term postoperative haematoma, the absence of unified indications for revision interventions. There are two cardinal surgical tactics in POH surgery: “waiting” with conversion to surgical treatment and early revision surgical treatment. The emerging trend in medicine to reduce the length of stay in the intensive care wards requires a careful analysis of the time intervals for the formation of the POH.
Objective . The aim was to determine the advantages of the strategy of early revision surgical treatment in comparison with the “waiting” tactic with conversion to surgical treatment of neurooncological patients with significant POH; to establish a reasonable period of stay of patients of the specified profile in intensive care unit wards.
Methods. The retrospective study included 48 neurooncological patients who were reoperated because of POH. The time intervals T1, T2, T, reop were calculated for each clinical case. All patients were divided into 2 groups: in group 1, the strategy of early revision intervention was used, in group 2, “waiting” conservative tactics were used, followed by conversion to revision intervention. Outcomes were estimated using a modified 5-point Glasgow Outcome Scale.
Results. When using the strategy of early revision intervention, significantly better outcomes were obtained (Mann-Whitney test, p value = 0.006717). The median outcome in the 1st group is moderate disability, in the 2nd group is severe disability. Based on the calculation of time parameters, a rational observation period for patients in the intensive careunit was established – at least 2 days, a diagnostic algorithm for the POH was determined.
Conclusion. Our data obtained indicate the advantages of the strategy of early revision intervention. When choosing an approach to the surgical treatment of POH, it is necessary to be guided by the principle of interpreting doubts in favor of reoperation. Reducing the length of stay of neurooncological patients in intensive care unit will lead to belates detection of POH and worsening of disability and postoperative mortality rates.

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