Complications
This occurs in 1% to 2% of craniotomies and represents a baseline of infection risk for cranial surgery.[120] If infection occurs, it is treated with the appropriate antibiotic therapy directed by the isolated pathogen. Skull base meningiomas, which are associated with a higher risk of cerebrospinal fluid leak, may be associated with higher infection rates.
The likelihood of this complication is low but depends on the location of the tumour. Meningiomas located at the skull base are particularly associated with the development of postoperative cranial neuropathies, occurring in up to one third of cases.[121] In cases of functional disability, in-patient rehabilitation or physiotherapy may be necessary.
Onset may be months after treatment and may not be predictable. It is often treated with steroid therapy, anti-angiogenic therapy, anti-inflammatories, or in extreme cases, hyperbaric oxygen. Refractory cases may require tumour resection.
Preoperative seizures may be related to the tumour and its effect on the cerebral cortex. Seizures are treated with anticonvulsant therapy.[122] There is no way of predicting or preventing seizures. Patients may be administered anticonvulsant therapy at the time of surgical resection, with continuation for variable periods postoperatively.[46] Following acute surgery, the evidence is neutral, neither for nor against seizure prophylaxis.[123] More than 60% of patients will become seizure-free after meningioma removal.[124] The decision to start an anti-epileptic drug for seizure prophylaxis is ultimately guided by assessment of individual risk factors and careful discussion with patients. Patients who had preoperative seizures should be monitored by a neurologist in order to guide the weaning of anti-convulsant-epileptic medication postoperatively.
Patients with brain tumours have an increased risk of vascular complications, including venous thromboembolism (VTE) and ischaemic stroke.[122] One systematic review reported a median rate of VTE following meningioma resection of 4.6% (range: 2.1% to 29.8%); fewer patients who received low molecular weight heparin developed a VTE.[125]
Radiotherapy may increase the long-term risk of stroke. One prospective trial reported that 20% of patients experienced a stroke following fractionated combined proton-photon radiotherapy, while one systematic review found a long-term stroke rate of 1.7% following single-fraction, photon-based stereotactic radiosurgery for non-malignant meningioma.[126][127]
Neurological symptoms related to the tumour can mask signs and symptoms of VTE and make diagnosis challenging.[122] Guidelines on the diagnosis and management of vascular complications in patients with brain cancer are available.[122]
Use of this content is subject to our disclaimer