Postoperative fibrinogen deficiency after surgical removal of intracranial tumors: Prevalence, risk factors and prognosis.

Background: Postoperative fibrinogen deficiency after surgical removal of a brain tumor can cause potentially serious complications, such as intracranial hematoma, and worsen the patient's outcome. Our study aimed to determine the prevalence of hypofibrinogenemia after resection of intracranial tumor, to identify the risk factors for this abnormality, and to evaluate the prognosis of patients with this hemostasis disorder.

Methods: We conducted a prospective, descriptive study including 120 patients who presented for brain tumor resection without preoperative fibrinogen deficiency and had given their consent to participate in the study. We determined the fibrinogen level the day before the procedure, at 1 h and 24 h postoperatively. We determined the prevalence of postoperative fibrinogen deficiency. Postoperative complications, neurological status of the patient, and mortality at 3 months were subsequently recorded.

Results: Forty-eight patients presented postoperative fibrinogen deficiency with a high prevalence of 40%. Our study identified three predictive independent risk factors of fibrinogen deficiency after surgical resection of brain tumor: histological type of meningioma (P = 0.015), prolonged duration of surgery (more than 195 min) (P = 0.045), and use of surgicel as a hemostatic product intraoperatively (P = 0.009). Postoperative hematoma and sensory-motor deficit were significantly associated with postoperative fibrinogen deficiency (P < 0.001). Patients with postoperative hypofibrinogenemia had worse Glasgow Outcome Scale-Extended at discharge and after 3 months. On the other hand, fibrinogen deficiency after surgical removal of the intracranial tumor was not significantly associated with increased postoperative mortality.

Conclusion: We found a high prevalence of hypofibrinogenemia after brain tumor resection (40%). This anomaly increases the risk of intracranial hematoma. It, therefore, deserves the attention of the practitioner to correct it rapidly and avoid its potentially serious complications.