Blood Conservation for Complex Spine and Intracranial Procedures

Abstract

Neurological surgery, which includes intracranial and spine surgery, is associated with a significant risk of major perioperative bleeding. This review highlights the various blood conservation techniques currently in practice for major, complex spine and intracranial surgery. Several techniques have been described to reduce blood loss and transfusion requirements perioperatively. These include preoperative risk identification and stratification and use of different blood conservation strategies perioperatively. The efficacy and safety of tranexamic acid has been demonstrated in major spine surgery, and its role has expanded in traumatic brain injury based on the CRASH-3 study. Permissive hypotension should be avoided based on recent high-quality observational data on the negative effects of cumulative hypotension on end-organ injury. The use of viscoelastic blood coagulation management is increasingly used as a theragnostic approach to blood conservation strategies. The ability to minimize blood loss and reduce exposure to allogeneic blood transfusions, which can greatly increase perioperative morbidity and mortality, is paramount. Our review provides a framework for evidence-based blood conservation strategies for neurological surgery.