A Perioperative Management to Reduce Pulmonary Embolism after Meningioma Resection

Aim: Meningiomas have the highest postoperative complication rate with pulmonary embolism (PE) among all intracranial tumors. The aim of this study is to find a management to reduce PE after meningioma resection.

Methods: Two cohorts of the years 1999 to 2006 (n1 = 482) and 2008 to 2010 (n2 = 242) have been treated with different PE managements and reviewed retrospectively. Low-molecular weight heparin (LMWH) and compression stockings are applied with the management of 1999 to 2006.

The new management of 2008 to 2010 includes intraoperative 10- to 20-degree leg extension with intermittent pneumatic compression (IPC), heparin, and LMWH administration. Compared was the incidence of the end points PE, deep vein thrombosis (DVT), hemorrhage, and death, taking into account several known associated risk factors. In both cohorts a subgroup with cranial base meningiomas was assessed for complications.

Results: No evidence for differences between the cohorts has been detected for age, body mass index, gender, World Health Organization grade, preoperative embolization, and paresis. There was evidence for a shorter stay in neurosurgery but longer surgery times in the 2008 to 2010 cohort.

We found no evidence for differences in the incidence of thrombosis, hemorrhage, and death. There was a significant reduction in the PE incidence (odds ratio [OR]: 0.3 with 95% CI, 0.11–0.66; p = 0.0021). A stratified analysis dividing patients into cranial base or other localizations gave similar results (cranial base: OR = 0.30 with p = 0.03; other: OR = 0.26 with p = 0.039). After adjustment for the considered confounders, the OR decreased further to 0.21 (95% CI, 0.05–0.69; p = 0.007).

Discussion: Patients with cranial base localization had a higher risk for PE (OR: 2.77 with 95% CI, 1.15–7.07; p = 0.01). A stratified adjusted analysis suggests a higher benefit for patients with cranial base localization in the prophylaxis of DVT (p = 0.02) and overall complications (p = 0.05), but not for PE (p = 0.16).

Conclusion: We recommend a PE prophylaxis management composed of heparin, LMWH, IPC, and adjusted intraoperative positioning. This reduces the risk for PE significantly and shortens postsurgical hospital stay after meningioma resection.