Is postoperative haematoma an avoidable complication of intracranial surgery?

Postoperative intracranial haematoma is a serious complication of intracranial surgery with a mortality rate of around 30%. There have been reports implicating abrupt rises of blood pressure during the last stages or immediately after the procedure, in the production of the clot. This prospective study examined this hypothesis. Over the last 7 years, 526 consecutive patients underwent craniotomy under a strict anaesthesiological protocol based on deep opioid analgesia which virtually eliminated any acute elevations of the arterial pressure during and immediately after craniotomy. Emergence from anaesthesia was delayed for an average of 1 1/2-2 h following the procedure. Postoperative CT was obtained in every patient. There have been no cases of postoperative clot formation in this series of patients. The results of the study suggest that postoperative haematoma is probably an avoidable complication of intracranial surgery.