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Factor XIII deficiency as a potential cause of supratentorial haemorrhage after posterior fossa surgery

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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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Authors and Affiliations

  1. Critical Care Department and Pulmonary Services, Evangelismos General Hospital, University of Athens Medical School, 45-47, Ipsilandou Street, Athens, GR-10675, Greece

    Charikleia Spyridon Vrettou, Spyridon Halikias, Magdalini Kyriakopoulou, Spyridon Kollias & Antonia Koutsoukou

  2. Department of Neurosurgery, Evangelismos Hospital, University of Athens Medical School, Athens, Greece

    Lampis C. Stavrinou & George Stranjalis

Authors
  1. Charikleia Spyridon Vrettou
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  2. Lampis C. Stavrinou
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  3. Spyridon Halikias
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  4. Magdalini Kyriakopoulou
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  5. Spyridon Kollias
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  6. George Stranjalis
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  7. Antonia Koutsoukou
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Corresponding author

Correspondence to Charikleia Spyridon Vrettou.

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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

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