Abstract
Perioperative infarction in brain tumor surgery occurs in about 30–80% of cases and is strongly associated with poor patient outcomes and longer hospital stays. Risk factors contributing to postoperative brain infarction should be assessed. We retrospectively included all patients who underwent surgery for brain metastases between January 2015 and December 2017. Hemodynamic parameters were analyzed and then correlated to postoperative infarct volume and overall survival. Of 249 patients who underwent biopsy or resection of brain metastases during that time, we included 234 consecutive patients in this study. In total, 172/249 patients showed ischemic changes in postoperative magnet resonance imaging (MRI) (73%). Independent risk factors for postoperative brain infarction were perioperative blood loss (rho 0.189, p = 0.00587), blood glucose concentration (rho 0.206, p = 0.00358), blood lactate concentration (rho 0.176; p = 0.0136) and cumulative time of reduced PaCO2 (rho −0.142; p = 0.0445). Predictors for reduced overall survival were blood lactate (p = 0.007) and blood glucose levels (p = 0.032). Other hemodynamic parameters influenced neither infarct volume, nor overall survival. Intraoperative elevated lactate and glucose levels are independently associated with postoperative brain infarction in surgery of brain metastases. Furthermore, they might predict reduced overall survival after surgery. Blood loss during surgery also leads to more cerebral ischemic changes. Close perioperative monitoring of metabolism might reduce those complications.
Highlights
Perioperative infarction in brain tumor surgery occurs in about 30–80% of the cases and may lead to persistent neurological deficits and a delay of recovery [1,2,3,4]
The following data were assessed for every patient: clinical data including past medical history of high blood pressure, diabetes, peripheral arterial occlusive disease (PAOD), previous thromboembolic events, smoking status, pre- and postoperative Karnofsky Performance Status Scale (KPS), date of initial tumor diagnosis, as well as of surgery, histopathological workup, systemic metastases, date of death or last contact and dates of recurrence
This analysis of a patient having undergone resection of brain metastases, This of of a hemodynamic patient collective, having undergone of brain metastases, did not confirm theanalysis relevance parameters, as the mean resection intraoperative diastolic blood pressure confirm the relevance of hemodynamic parameters, as the mean intraoperative diastolic blood only reached borderline significance
Summary
Perioperative infarction in brain tumor surgery occurs in about 30–80% of the cases and may lead to persistent neurological deficits and a delay of recovery [1,2,3,4]. Infarct volume in glioblastoma surgery has proven to be an independent prognostic factor, as postoperative neurological deficits have been proven to be associated with decreased overall survival and lower quality of life [5,6]. Recent studies revealed intraoperative diastolic blood pressure, fluid balance and length of surgery as independent factors for development of postoperative ischemia [10]. Mean intraoperative diastolic blood pressure and middle arterial blood pressure were significant prognostic factors in a multivariate analysis in patients with glioma surgery. Data analyzing brain infarction after resection of brain metastases are rare
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