Characterization and prognostic implications of significant blood loss during intracranial meningioma surgery

Background: Surgery for intracranial meningiomas enables the timely reduction of mass effect and can even be curative; however, it is often accompanied by substantial bleeding. We investigated the risks for significant intraoperative bleeding and the impact of excessive blood loss on the in-hospital outcomes in patients undergoing resection of intracranial meningiomas. Methods: We retrospectively enrolled 99 patients that had undergone intracranial meningioma operation. Significant blood loss during an operation was defined as ≥500 mL blood volume. The cases were divided into two groups: those with (N=60) and without (N=39) significant blood loss. Results: The rate of significant intraoperative bleeding in the 99 patients was 60.6%. In a multivariate logistic regression analysis, the independent risk factors for significant blood loss were the size of tumors (P=0.006) and operative duration (P=0.002). In addition, significant blood loss during meningioma surgery predisposed patients to a higher rate of 30-day medical complications (P=0.001). The duration of postoperative ventilator support, the length of the intensive care unit (ICU) stay, and the length of the hospital stay were significantly prolonged in patients with excessive bleeding (P=0.012, P=0.007, and P < 0.001, respectively). Conclusions: In intracranial meningioma surgery, larger tumors and prolonged operations increase the risk of substantial bleeding. Because significant blood loss during meningioma resection is associated with higher incidence of medical morbidities, neurosurgeons would be advised to pay increased attention to this outcome determinant.