Testing Hemostasis by Raising Blood Pressure at the End of Elective Neurosurgery: An Observational Study

Abstract Testing surgical hemostasis via blood pressure (BP) augmentation at the end of brain tumor resection is a common but underevidenced practice, although routinely requested by neurosurgeons. We aimed to assess whether an increase in systolic arterial BP (SAP) influenced the need for adjunctive neurosurgical maneuvers by identifying new bleeding spots (NBS) and to evaluate the impact of the corresponding mean arterial BP (MAP) on hemostasis and the occurrence of postoperative intracranial hemorrhage. We included adult patients who underwent elective supratentorial neoplastic neurosurgery. We recorded SAP, MAP, and diastolic arterial BP during the preoperative visit and at various stages of anesthesia, hemostasis, and at the end of surgery. The first brain computed tomography (CT) scan was performed within 24 hours postoperatively to detect any postoperative hemorrhages, using an institutional grading system (“C/E score”). A controlled increase in SAP at the end of tumor ablation identified previously unnoticed bleeding points in nearly half of patients, enabling timely hemostatic intervention. During maintenance, MAP was the only variable predictive of NBS (odds ratio 0.953 [95% confidence interval 0.918–0.987; p = 0.0086]). No correlation was found between NBS or the achieved MAP value and neuroradiological evidence of postoperative hemorrhage. Postsurgery CT revealed surgical cavity blood effusions (58.4% mild, 3.2% moderate) and surrounding parenchymal hemorrhages (34.7% mild, 3.2% moderate, 0.5% severe). An increase in SAP at the end of tumor ablation appeared to improve hemostatic accuracy in approximately 45% of cases. Maintaining an adequate MAP during maintenance was important, although it did not correlate with postoperative intracranial hemorrhage. The trial was registered on Clinicaltrials (NCT05874050).