The Warburg effect and intraoperative hyperlactatemia in brain tumor resection: A case report

Hyperlactatemia is a common occurrence during neurosurgical procedures, typically associated with hypoxia. This case report describes a significant episode of intraoperative hyperlactatemia in a 22-year-old female undergoing craniotomy for the resection of a mesial frontotemporal brain tumor, which was managed without signs of hypoperfusion. Despite conventional management strategies aimed at correcting hypotension and metabolic acidosis, lactate levels escalated to 12.3 mmol/L, accompanied by severe hyperglycemia. The patient's condition stabilized postoperatively with lactate levels normalizing by the second day in the ICU. This case suggests that the Warburg effect, a metabolic phenomenon characterized by enhanced aerobic glycolysis by tumor cells leading to excessive lactate production, was a significant contributor to the observed hyperlactatemia. The recognition of non-hypoxic hyperlactatemia is crucial in guiding appropriate intraoperative management and avoiding unnecessary interventions. This report underscores the importance of considering tumor metabolism, particularly the Warburg effect, in the differential diagnosis of hyperlactatemia during surgery, which could influence intraoperative decisions and potentially affect patient outcomes.