Analysis the reasons of emergency reoperation after skull base surgery: report of 14 cases

Abstract

Objective To report the clinical features of the patients who underwent emergent re-craniotomy after skull base operation. Methods A serial of 14 cases of reoperation after elective surgery in the Department of Neurosurgery, Beijing Tiantan Hospital between October 2008 and October 2013 were reviewed. Six cases were skull basal meningioma, 3 schwannoma, 1 pituitary adenoma, 1 craniopharyngioma, 1 chondroma, 1 angioleiomyoma, and 1 glomus jugular tumor. The mean length of first operation time was 9.2 h, and the mean amount of bleeding was 2 750 ml. The reason of reoperation was evaluated by the surgeons and experts, and then approved by all doctors. Results The clinical features of these reoperation patients included altered level of consciousness in 9 cases, unrecovered from anesthesia in two, abnormal CT scan in two and one sudden bleeding in wound. The mean time of abnormal CT scan was 17 h. As for the reason for reoperation, the tumor cavity bleeding was found in 4 cases, intracerebral hematoma and brain contusion in 4, massive brain infarction in 2, intracerebral hematoma and subdural hematoma in 1, epidural hematoma in 2, and vertebral artery dissection in 1. Six patients lived a normal life after the second operation, 2 moderate disability, 2 severe disability, 1 persistent vegetative state, and 3 died. Conclusion For skull base surgery, the perioperative management should be reinforced to decrease the emergency reoperation. Key words: Neurosurgical procedures; Skull base neoplasms; Reoperation