NCOG-14. THE ROLE OF POSTOPERATIVE BLOOD PRESSURE MANAGEMENT IN EARLY POSTOPERATIVE HEMORRHAGE IN AWAKE CRANIOTOMY GLIOMA PATIENTS

Abstract INTRODUCTION Awake surgery is widely used to maximize the extent of resection and enhance neuro-oncological outcome in gliomas. Postoperative hemorrhage can severely deteriorate the patients’ neurological outcome. Higher postoperative blood pressure can increase the risk of postoperative hemorrhage, but optimal perioperative patient and blood pressure management is unclear. The aim of this study was to investigate the role of postoperative blood pressure and other common radiological and epidemiological features with the incidence of postoperative hemorrhage. MATERIAL & METHODS In this retrospective analysis, we included all patients who underwent awake surgery between 2010 and 2023 at our institution. We assessed the blood pressure both intra- and postoperatively as well as the heart rate for the first 12 hours. We compared a cohort with postoperative hemorrhage, who required further treatment (surgical revision or intravenous antihypertensive therapy), with a cohort with no postoperative hemorrhage. RESULTS We included 48 patients with a median age of 39 years. 9 patients (19%) showed a preoperative history of arterial hypertension, 8 of them were on antihypertensive treatment. 23 patients (48%) showed signs of a hemorrhage on early postoperative MRI, of whom 9 (19%) required further treatment, which was surgery in 2 cases and conservative therapy in 7 cases. Patients with postoperative hemorrhage showed significantly higher postoperative systolic blood pressure during the hours 3-12 (p<0.05) as well as intraoperatively during the hours 1-5 (p<0.05). In ROC and Youden Test, a strong impact of systolic blood pressure over 140 mmHg during the early postoperative course could be shown. DISCUSSION Postoperative hemorrhage is a serious complication in awake surgery glioma patients. However, with early treatment, no significant difference in Performance scores at follow-up could be found. To avoid postoperative hemorrhage, treating physicians should aim strictly on systolic blood pressure of under 140 mmHg for the postoperative course.