Abstract
Background
Postoperative intracranial haemorrhage can be a dramatic event, carrying significant morbidity and mortality. Bleeding at sites remote from the operation area represents a small percentage of haemorrhages whose aetiology remains unclear (Harders et al. Acta Neurochir (Wien) 74(1-2):57–60, 1985).
Aim
We present the case of a 60-year-old patient who underwent posterior fossa craniotomy for the removal of a space-occupying lesion and suffered supratentorial haemorrhage soon after the operation.
Results
A thorough postoperative investigation revealed low levels of factor XIII (FXIII), the factor mainly responsible for fibrin clot stabilisation.
Conclusion
We suggest that reduced FXIII activity may be an important but preventable predisposing factor to remote postoperative haemorrhage in neurosurgical patients.
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Comment
The authors describe the case of supratentorial hematoma following infratentorial surgery and found a decreased coagulation factor XIII (FXIII). They point out, that the decreased FXIII might be associated in the development of bleeding remote from the surgical site. There are various series investigating the role of decreased FXIII in Neurosurgery.
This case report emphasizes the necessity of thorough diagnostics evaluation of coagulation abnormalities in bleeding complications after uneventful surgical procedures. A global screening of coagulation abnormalities including FXIII activity is of paramount importance to initiate adequate replacement therapy to correct coagulation abnormality in the acute situation and to prevent bleeding complications during further surgical procedures, such as VP-Shunting etc.
Rüdiger Gerlach and Volker Seifert
Frankfurt, Germany
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Vrettou, C.S., Stavrinou, L.C., Halikias, S. et al. Factor XIII deficiency as a potential cause of supratentorial haemorrhage after posterior fossa surgery. Acta Neurochir 152, 529–532 (2010). https://doi.org/10.1007/s00701-009-0432-0
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DOI: https://doi.org/10.1007/s00701-009-0432-0