Postoperative Hematoma

Definition

Development of a postoperative hematoma is a common complication after intracranial surgery; the gravity depends on the amount of collected blood. Some amount of blood may be frequently seen on subsequent scan in almost 10.8–50% of operated patients. For practical purpose, we define postoperative hematoma as intracranial collection of blood following craniotomy which is clinically symptomatic and requires evacuation. On this basis, the incidence varies from 0.8 to 6.9%.

Site

The site of hematoma may be at primary surgical site or at a remote area away from the operative field. It can be subdural, epidural, or intraparenchymal. Acute brain decompression may cause rupture of a bridging vein causing subdural hematoma away from the site of surgery. In cases where dura is stripped from skull, bleeding from middle meningeal artery may lead to formation of an epidural hematoma.

Risk factors/predisposing factors:

• Uncontrolled hypertension

• Bleeding disorders

• Drug therapy—aspirin, clopidogrel, heparin, low molecular weight heparin.

• Vascular disease

• Hypothermia

Causes

• Coagulopathies and hematological abnormalities

• Drug-causing coagulation disorders

• Intraoperative hypertension

• Massive blood loss/dilutional coagulopathy

• Excessive brain dehydration and cerebrospinal fluid drainage

• Retraction injury

• Residual tumor

• Inadequate surgical hemostasis

• Normal pressure perfusion breakthrough