[Blood loss in surgery of brain tumors in infants]

Functional immaturity of all organs and systems result in a high risk of complications in surgery of brain tumors in infants. One of the most serious complications is a massive blood loss and developing on its background severe disorders of hemostasis. In modern series of observations perioperative mortality in these children varies from 13 to 33%. The purpose of this paper--based on an analysis of topography, morphology and features of the operations to determine risk groups of blood loss in surgery of brain tumors in infants and suggest the best options for surgical tactics. When operating blood loss exceed 300% of the calculated blood volume persistent violations of coagulation homeostasis develop, which can lead to uncontrolled bleeding and death on the operating table, or post-operative bleeding. Intraoperative blood loss could be reduced by surgical techniques improvement, as well as by improving of anesthesia. First type includes preoperative embolization of the afferent vessels, careful planning of surgical approach, including using neuronavigation, deep stromal tumor coagulation during debulking, primary coagulation of main feeding blood vessels, two-stage surgery, and optimization of speed of tumor removal. All these methods has reduced the overall operational and post-operative mortality rate from 13 to 5%.