Urgent reoperation for major regional complications after removal of intracranial tumors: outcome and prognostic factors in 100 consecutive cases

Abstract

Outcome of urgent reoperation for major regional complication after removal of intracranial tumor was evaluated retrospectively in 100 consecutive patients treated since 1983. Urgent reoperation was performed from 3 to 240 hours (mean 74 hours) after primary surgery for 32 meningiomas, 23 pituitary adenomas, 22 gliomas, 13 vestibular schwannomas, and 10 other intracranial neoplasms. Mean Glasgow Coma Scale (GCS) score before reoperation was 8. Brain edema was the most frequent operative finding at reoperation (31 patients), followed by extradural hematoma (25) and brain ischemia (24). Removal of various types of intracranial hematomas was the most common surgical procedure at reoperation (47 cases). Final outcome was considered favorable in 54 patients, who were discharged without major neurological deficit, and unfavorable in 46, with severe disability or vegetative state in four and death in 42. Multivariate analysis showed statistically significant association with the outcome for histological type of the tumor (p < 0.0001), clinical state at admission (p < 0.001), GCS score before urgent reoperation (p = 0.001), time interval between primary surgery and urgent reoperation (p < 0.01), and patient age (p < 0.05). Therefore, the outcome after urgent reoperation due to major regional complications after removal of intracranial tumor is determined mainly by the clinical condition of the patient and characteristics of the tumor, and less influenced by the type of complication.