Is postoperative deep vein thrombosis a problem in neurosurgical patients with brain tumours in Singapore?

To prospectively establish the incidence of deep vein thrombosis (DVT) after cranial procedures in patients with brain tumour in Singapore.

Over a period of one year from June 1995 to May 1996, 106 consecutive patients were recruited into the study. All patients undergoing surgery within the period of study were included. Each patient underwent a preoperative and postoperative (on postoperative Day 5 to Day 7) ultrasound examination of the lower limbs to establish the presence of DVT. Prophylaxis was limited to the peri-operative use of elastic stockings on hemiparetic limbs. There were 56 males and 50 females aged between 22 to 86 years (median 45 years). Ethnicity was Chinese, 92% Indian, 6% and other 2%. Ninety percent of the patients were ambulant pre- and post-operatively. No patient had a prior history of DVT. The distribution by pathologic diagnosis was brain metastases, 26% meningioma, 26% glioma, 19% pituitary adenoma, 14% acoustic neuroma, 6% and 9% miscellaneous tumours.

DVT was identified in 5/106 patients (4.7%), all of whom had either meningioma or glioma. All five cases occurred in supratentorial tumours. The tumour specific incidence was 7.1% for meningioma and 15% for glioma. 4/5 patients (80%) had pre-existing hemiparesis of the affected limb. No patient developed clinical pulmonary embolism.

The overall incidence of postoperative DVT in our population, using minimal prophylaxis, was not significantly different from the best results of prospective studies on North American or European patients employing a full regime of prophylaxis. The high-risk groups were similar. Prophylaxis using subcutaneous heparin should be used cautiously in high-risk patients.