Early postoperative perils of intraventricular tumors: An observational comparative study.

Schär, Ralph T.; Schwarz, Christa; Soell, Nicole; Raabe, Andreas; Z'Graggen, Werner Josef; Beck, Jürgen (2018). Early postoperative perils of intraventricular tumors: An observational comparative study. World neurosurgery, 113, e769-e776. Elsevier 10.1016/j.wneu.2018.02.177

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OBJECTIVE

Early postoperative patient surveillance after removal of intraventricular tumors is often hindered by delayed awakening and prolonged somnolence. The objective of this study was to analyze the incidence of early critical postoperative events after elective craniotomies for intraventricular tumors in adults as compared to extraventricular lesions.

METHODS

An observational comparative study was conducted on adult patients who had undergone first-time elective craniotomies from November 2011 until August 2016. Patients were stratified into extraventricular lesions (group 1) and intraventricular tumors (group 2). The rates of late extubation, early postoperative seizures, emergency head CTs, and urgent surgical intervention within 48 hours and mortality within 30 days of surgery were analyzed from a prospective database.

RESULTS

A total of 977 elective craniotomies were analyzed: group 1 (951 patients, 97.3%) vs. group 2 (26, 2.7%). In group 2 emergency CTs were significantly more often ordered (rate 34.6 % vs. 8.4%; OR 5.76, 95% CI 2.49-13.35, p = 0.0002), and the incidence of urgent surgical intervention was significantly higher (rate 11.5% vs. 0.8%; OR 15.38, 95% CI 3.83-61.72, p = 0.002) than in group 1. Main reason for urgent surgical intervention in group 2 was acute obstructive hydrocephalus. Overall surgical mortality after 30 days was 0.3% (3 cases in group 1, no case in group 2).

CONCLUSION

Intraventricular tumors are at significantly higher risk for early emergency head CT and urgent surgical intervention. This patient cohort might benefit from routine intra- and early postoperative imaging, as well as intraoperative extraventricular drain placement.

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