gms | German Medical Science

Objective: The sudden death of neurosurgery patients is not uncommon. Among expired patients, considerable number of patients died from systemic cause rather than brain lesion. Especially, if the cause of death were not related to the brain lesion, we did not find hardly the reason. In order not to suffer the chagrin of losing patients even good surgical results, we reviewed our unexplained deaths and discussed about preventions of most common cause.

Method: There were 147 cases of death at the department of neurosurgery of SMG-Seoul National University Boramae Medical center from Jan of 2012 to Sep of 2015. Among them, 8 patients died within a few hours after onset of symptoms.

Results: The most common suspected cause was pulmonary thromboembolism (3 patients). Among them, only 1 patient was confirmed as pulmonary thromboembolism and other 2 patients could not do confirmative diagnostic test, such as pulmonary CT angiography. But their laboratory findings and clinical symptoms strongly suggest that pulmonary thromboembolism were the main cause of their deaths.

Conclusions: After a surgical treatment such as ICH evacuation, decompressive craniectomy, pharmacologic prophylaxis using anticoagulant is burden especially for neurosurgeon, but neurosurgical patients are also at an increased risk of thrombosis. Fortunately, there are no strong evidence that pharmacologic prophylaxis is better than mechanical prophylaxis. So, active mechanical prophylaxis using intermittent pneumatic compression (IPC) and close observation are essential and aggressive evaluation using d-dimer, ultrasonography, and CT scan is needed if patients present the sign of sudden hypotension or desaturation.