Liver cirrhosis, a devastating liver fibrosis caused by hepatitis/inflammation or tumors, is a major comorbid factor in known surgery fields, such as cardiovascular and abdominal surgeries. It is important to review possible comorbid results in neurosurgical procedures in cirrhotic patients. In the reviewed literature, Child-Pugh and model for end-stage liver disease scores are commonly used in the assessment of surgical risks for cirrhotic patients undergoing abdominal, cardiovascular or neurosurgical procedures. The major categories of neurosurgery are traumatic brain injury (TBI), spontaneous intracranial hemorrhage (SICH), brain tumors, and spinal instrumentation procedures. TBI was reported with surgical mortality as high as 34.5% and a complication rate of 87.2%. For SICH, mortality ranged from 22.7% to 47.0%, while complications were reported to be 43.2%. Less is discussed in brain tumor patients; still the postoperative hemorrhage rate approached 26.7%. In spinal fusion instrumentation procedures, the complication rate was as high as 41.0%. Preoperative assessment and correction could possibly decrease complications such as hemorrhage, wound infection and other cirrhosis-related complications (renal, pulmonary, ascites and encephalopathy). In this study, we reviewed the neurosurgical-related literature with regard to liver cirrhosis as a prognostic factor influencing neurosurgical outcomes.
Keywords: Brain tumor; Complications; Liver cirrhosis; Neurosurgery; Spine surgery; Spontaneous intracranial hemorrhage; Surgical risks; Traumatic brain injury.
Spontaneous Intracranial Hemorrhage in Cirrhotic PatientsHH Huang et al. Clin Neurol Neurosurg 110 (3), 253-8. PMID 18194837.SICH occurs primarily in young males with mild-to-moderate alcoholic cirrhosis of the liver. The etiology of cirrhosis is related to the incidence of SICH, but not to the …
Brain Surgery in Patients With Liver CirrhosisCC Chen et al. J Neurosurg 117 (2), 348-53. PMID 22631693.Liver cirrhosis is a poor comorbidity factor for brain surgery. The authors' results suggest that the Child classification used independently is a poor prognostic factor; …
Complications Associated With Instrumented Lumbar Surgery in Patients With Liver Cirrhosis: A Matched Cohort AnalysisJC Liao et al. Spine J 13 (8), 908-13. PMID 23541455.The rate of complications after instrumented lumbar surgery was significantly higher in patients with cirrhosis than in control patients, especially in those with 6 or mo …
Surgery in a Patient With Liver DiseaseR Rai et al. J Clin Exp Hepatol 2 (3), 238-46. PMID 25755440. - ReviewSurgery is often needed in patients with concurrent liver disease. The multiple physiological roles of the liver places these patients at an increased risk of morbidity a …
Patterns in Neurosurgical Adverse Events: Intracranial Neoplasm SurgeryJM Wong et al. Neurosurg Focus 33 (5), E16. PMID 23116096. - ReviewReview of the tumor neurosurgery literature showed that documented overall complication rates ranged from 9% to 40%, with overall mortality rates of 1.5%-16%. There was a …