Perioperative Haemostatic Management in a Patient Undergoing Craniotomy for Excision of Meningioma: Role of Thromboelastography

Abstract

Although there is a general predisposition towards hyper-coagulability during brain tumour surgery, hypocoagulability may exist in certain cases even before surgery, detectable only when the physical characteristics of clot formation are studied by viscoelastic point-of-care tests like thromboelastography (TEG). Herein we present a case of a 66-year old male patient with left frontal convexity meningioma, scheduled for craniotomy and excision of tumor. Patient’s preoperative coagulation profile (as assessed by conventional tests) was within normal limits but he was bleeding profusely from the beginning of the surgery and there was massive bleeding during tumour resection. Based on findings of TEG which revealed a severe hypocoagulable picture (low α angle, MA value and CI value with high K value), 10 units of cryoprecipitate and 4 units of random donor platelets were transfused intra-operatively in addition to 2 units of PRBCs.
Haemodynamic stability was achieved and subsequent intra-operative course was better. One more unit of PRBC was transfused in the immediate post-operative period and a repeat TEG after 4 hours showed a trend towards normalization of TEG parameters suggesting a restoration of coagulation competency which also correlated with improved clinical condition of the patient.