Delayed post-operative haemorrhage after carmustine wafer implantation: A case series from two UK centres

Abstract

Object. Significant haemorrhage following intracranial tumour resection may occur in 1–2% of cases and the majority occur within the first few hours post-operatively. Implantation of carmustine wafers has been associated with increased operative site complications in some series, but post-operative haematoma is not routinely reported. We analyzed the characteristics of post-operative haemorrhage after carmustine wafer insertion. Methods. We performed a retrospective audit of surgical site haematoma after tumour resection and insertion of carmustine wafers in two neurosurgical units in the UK (University Hospital of North Staffordshire, Stoke-on-Trent, March 2003 – July 2012; Wessex Neurological Centre, Southampton, October 2005 – January 2013). Results. During the specified time periods, carmustine wafers were inserted in 181 operations in 177 patients. We identified acute operative site haematomas after carmustine wafer insertion in 8 (4.4%) patients. All presented in a delayed fashion on or after Day 2 post-operatively. In contrast, acute operative site haematoma was present in 4/491 (0.81%) of patients who underwent resection without gliadel wafer insertion. Conclusions. In contrast to the expected timing of bleeding following intracranial tumour resection, all carmustine wafer patients who experienced haemorrhage presented in a delayed fashion on or after Day 2 post-operatively. The causative factors for universally delayed post-operative haematoma after carmustine wafer insertion are unclear and further studies are required to characterize this phenomenon.

Keywords::

• carmustine
• craniotomy
• gliadel
• high-grade glioma
• post-operative haemorrhage

Acknowledgements

We acknowledge the support of Mr. Jonathan Duffill (WNC), Mr. Rupert Price (UHNS) and the late Mr. Jagmohan Singh (UHNS) as the other neuro-oncology surgeons in the series.

Declaration of interest: The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.