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Coagulation study in patients who had undergone surgery for meningioma
F Dragoni1, M G Mazzucconi, M Acqui
1Department of Human Biopathology, University 'La Sapienza', Rome, Italy.
Abstract:
Abnormal fibrinolysis and thrombotic complications have been often observed in patients who had undergone surgery for meningioma. Fourteen patients, affected by meningioma, were studied before surgery, during surgery and 24 h after surgery in order to evaluate the modifications of the fibrinolysis system and the coagulation physiological inhibitors. Before surgery, no patient showed hyperfibrinolysis and/or modifications of coagulation physiological inhibitors. During surgery, an activation of fibrinolysis with pathological levels of tissue plasminogen activator activity (mean = 6.33 U/dl, SD = 7.9, p = 0.02) and increased levels of fibrin degradation products (mean = 0.21, SD = 0.18, p = 0.002) was noted. Modifications of the fibrinolysis parameters occurred only in 9/14 patients (64%). These patients presented a more vascularized tumour, revealed before surgery by computerized tomography scan and cerebral arteriography and directly confirmed during the resection. Twenty-four hours after surgery no patient presented fibrinolysis activation. There was no evidence of disseminated intravascular coagulation in our patients. None of them presented pathological decrease of the physiological coagulation inhibitors or thrombotic complications. In conclusion, during surgery, fibrinolysis parameters show important modifications in patients with vascularized meningioma suggesting an ongoing tumour-host interaction. These variations must be taken in account, in order to plan timely a correct therapeutic approach.
Insights
Surgery for meningioma can activate fibrinolysis, especially in highly vascularized tumors. Monitoring these fibrinolysis changes during surgery is crucial for managing potential thrombotic complications in meningioma patients.
Area of Science:
- Neurosurgery
- Hemostasis and Thrombosis
Background:
- Patients undergoing meningioma surgery often experience abnormal fibrinolysis and thrombotic issues.
- Pre-operative assessment of fibrinolysis and coagulation inhibitors is essential.
Purpose of the Study:
- To evaluate changes in the fibrinolysis system and coagulation inhibitors during meningioma surgery.
- To correlate fibrinolysis modifications with tumor vascularity.
Main Methods:
- Studied 14 meningioma patients before, during, and 24 hours after surgery.
- Assessed tissue plasminogen activator activity and fibrin degradation products.
- Utilized computerized tomography and cerebral arteriography to determine tumor vascularity.
Main Results:
- No significant fibrinolysis or inhibitor changes were observed pre-surgery.
- Fibrinolysis activation, indicated by increased tissue plasminogen activator activity and fibrin degradation products, occurred during surgery in 64% of patients.
- These changes were more pronounced in patients with highly vascularized tumors.
- No patient showed disseminated intravascular coagulation or pathological decrease in coagulation inhibitors post-surgery.
Conclusions:
- Fibrinolysis parameters significantly change during surgery in patients with vascularized meningioma, suggesting tumor-host interactions.
- These intraoperative fibrinolysis variations require consideration for appropriate therapeutic strategies.