URGENT REVISIONS OF AN OPERATIVE WOUND AFTER REMOVAL OF INTRACRANIAL TUMORS: CAUSES AND EFFECTS
M.F. Chernov, N.I. Ivanov
Polenov Neurosurgical Institute
It is well-known that some complications of an early postoperative period following removal of intracerebral tumors demand urgent surgical intervention, i.e. revision of an operative wound. However, the results of such repeated operations have not been analyzed yet.
The retrospective analysis of 100 consecutive urgent revisions of operative wounds after removals of intracranial tumors which were performed in the neurooncologic department of the Polenov Neurosurgical Institute in1980-1996 is given.
The state of 68 patients before revision was characterized by the score of not more than 8 (Glasgo scale). The most frequent operative findings were brain edema (31%), brain ischemia (24%). Circulation disorders in remains of tumor after its subtotal removal were watched in 14 patients. Hematoma removal (47 cases), external decompression (24 cases), removal of tumor remnants (22 cases) were performed during revision.
The state of 54 discharged patients was satisfactory, bad results were observed in 46 cases (fatal outcome, severe disability). The multi-variant analysis revealed 5 statistically reliable factors determining an outcome: age (p<0.05), a period between the first operation and revision (p<0.005), a state before revision estimated on the basis of Glasgo scale (p<0.001), a state on admission estimated on the basis of Glasgo scale (p<0.001), histological structure of tumor (p<0.001).
The above prognostic factors can be used for determination of the most probable result of revision and, thus, for a choice of optimum tactics of treatment.