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[Perioperative management of intracranial hemorrhage related to hematological disease]
H Ochiai1, Y Yamakawa, T Ikeda
1Department of Neurosurgery, Miyazaki Prefectural Hospital, Japan.
Insights
Surgical intervention for intracranial hemorrhage in patients with hematological diseases can yield excellent outcomes. Optimal results are achieved when the underlying hematological condition is well-controlled or in remission before surgery.
Area of Science:
- Neurosurgery
- Hematology
- Oncology
Context:
- Intracranial hemorrhage (ICH) in patients with hematological diseases presents significant management challenges.
- Surgical treatment for ICH in this population is often approached with caution due to bleeding risks.
Purpose:
- To clarify surgical indications and perioperative management strategies for ICH in patients with hematological diseases.
- To evaluate the outcomes of surgical intervention based on the control status of the underlying hematological disorder.
Summary:
- Six patients with hematological diseases and ICH underwent surgical treatment.
- Patients were grouped based on hematological disease control: Group 1 (uncontrolled) and Group 2 (controlled).
- Surgical outcomes were excellent in Group 2, and in Group 1 when bleeding was corrected and infections prevented, particularly in Acute Myeloid Leukemia (AML) cases in remission.
Impact:
- Surgical treatment for ICH related to hematological diseases can be highly effective, even when conservative management is typically favored.
- Achieving remission of the underlying hematological disease is crucial for successful surgical outcomes in ICH patients.
- This study highlights the potential for improved patient survival and recovery through tailored perioperative care and timely surgical intervention.
Abstract:
Six patients with hematological disease complicated by intracranial hemorrhage were surgically treated in the last 2 years. In this study, in order to clarify indication for operation and perioperative management, 6 cases were classified into 2 groups. The details of each group were as follows: Group 1 was defined by the fact that the underlying hematological disease had not yet been controlled. (One case was ITP and the others were 2 AML cases). Group 2 was defined by the fact that the underlying hematological disease was well controlled. (One case was CML, one case was ATL and one case was ITP). A tendency to bleed was corrected in all patients of group 1 in the perioperative period. In the AML cases, prevention of infection was mandatory because both AML cases had been in remission, and no serious postoperative complication had occurred. The outcome of short term treatment was excellent in all but one case, in whom the recurrence of subdural hematoma caused death during the period 1 month after operation. On the other hand, no cases classified in group 2 needed specific hematological perioperative management and the short term treatment outcome was excellent. Since intracranial hemorrhage related to hematological disease has often been fatal, those patients were treated conservatively in most cases. However, from our analyses, we were able to emphasize that most intracranial hemorrhage related to hematological disease might be treated surgically and with good result, if the underlying hematological disease has entered the remission period.