Venous thromboembolism in neurosurgery

Clinicopathological features of venous thromboembolism (VT), such as pulmonary embolism (PE) and deep venous thrombosis (DVT), associated with intracranial diseases has not been clarified sufficiently in Japan. We investigated the clinical characteristics of VT in consecutive 3,595 group of patients retrospectively, who had been admitted to our department. The occurrence rate of VT was 0.22% (8 patients). There were 2 males (0.10%) and 6 females (0.31%) with the mean age of 70.9 years old, ranging from 54 to 83 years old. Three patients were diagnosed as PE and 5 as DVT. The background of intracranial diseases included cerebrovascular disease in 5 patients, brain tumor in 2, and post-resuscitation encephalopathy in 1. The mortality rate of PE seems to be extremely high, considering that all patients with PE suffered death within 4 hours. High risk patients of VT in our series were the elderly, fat persons, and females who suffered from cerebral stroke. Immobilization scoring at 4 or 5 on the modified Rankin's Scale is also estimated to be a risk factor for VT. Patients with cerebral hemorrhage tend to develop VT in the acute stage of the clinical course and those with other intracranial diseases present VT in the chronic stage. VT is relatively rare, but is still one of the severe complications in neurosurgical management so that, once having occurred, VT has a high likelihood of resulting in death. We should discern the high risk group for VT and make proper prophylaxis depending on the patients condition.