Clinical characteristics and causes of emergency reoperation after skull base surgery: a report of 14 cases

Objective: To investigate the clinical characteristics and causes of the patients who received an emergency reoperation involving a craniotomy after neurosurgery for skull base tumors. Materials and methods: A retrospective analysis was performed with 14 patients who underwent an emergency reoperation involving a craniotomy after received skull base surgery in the Skull Base and Brainstem Division of the Neurosurgery Department at Beijing Tiantan Hospital, Capital Medical University, between October 2008 and October 2013. The clinical characteristics and causes for reoperation were analyzed and determined by the surgeons and a group of experts and confirmed via consultation of the entire department. Results: There were 6 cases of skull base meningiomas, 3 cases of schwannoma, and 1 case each of pituitary adenoma, craniopharyngioma, osteochondroma, angioleiomyoma, and glomus jugular tumor. The mean length of the first surgery was 9.2 hours, and the mean blood loss was 2750 mL. Among the patients who underwent reoperation, 9 patients exhibited declined consciousness and vitality, 2 patients were identified as having an abnormal postoperative recovery from anesthesia, 2 patients were identified by a routine postoperative computed tomography (CT) examination and 1 patient had sudden bleeding from the wound. The average time to detect abnormalities via CT exam was 16.9 hours after surgery. There were 4 cases of intratumoral hemorrhage, 4 cases of intracerebral hematoma accompanied by cerebral laceration, 2 cases of massive cerebral infarction, 1 case of intracerebral hematoma complicated by subdural hematoma, 2 cases of epidural hematoma, and 1 case of bleeding from the vertebral artery. Conclusions: Perioperative management should be strengthened for patients who receive skull base surgery to reduce the incidence of reoperation.