Kienzler Jenny C, Fandino Javier
Department of Neurosurgery, Kantonsspital Aarau, Aarau, CHE.
Department of Neurosurgery, Hirslanden Medical Center Aarau and Zurich, Aarau, CHE.
Cureus. 2023 Dec 28;15(12):e51231. doi: 10.7759/cureus.51231. eCollection 2023 Dec.
Given the lack of guidelines regarding perioperative management of neurosurgical patients taking antiplatelet medication, a break of aspirin intake for elective brain surgery is recommended. To the best of our knowledge, only three clinical studies have been published comparing re-bleeding rates in patients undergoing elective brain surgery with and without aspirin. We present a case of an 81-year-old woman who was admitted for elective craniotomy and brain metastases resection. She presented with a right-sided hemianopsia for > two weeks and further investigation by magnetic resonance imaging (MRI) showed the left occipital lesion. For primary cardiovascular prevention, the patient was prescribed prophylactic low-dose aspirin 100 mg. A platelet function test on the day of admission detected highly pathological values. Surgery was scheduled the next day, and aspirin intake was paused. The platelet function test was repeated the morning before surgery. Interestingly, the test showed a 20% above-normal level platelet function. Craniotomy and tumor resection were performed in a routine fashion and no increased bleeding tendency was reported intraoperatively. Postoperatively, the right-sided hemianopsia was immediately regressive. MRI performed 24 hours after surgery demonstrated a complete tumor resection without any signs of rebleeding. The patient was discharged five days after surgery without any neurological deficits. The literature is limited and guidelines are missing on the topic of management of antiplatelet medication in elective brain surgery. As confirmed by the present case and a review of the literature, elective craniotomy and tumor resection under antiplatelet medication may be considered in certain cases with risk and benefit stratification. More data and randomized controlled trials are needed to confirm these findings.
鉴于缺乏针对服用抗血小板药物的神经外科患者围手术期管理的指南，建议在进行择期脑手术时中断阿司匹林的服用。据我们所知，仅发表了三项临床研究，比较了接受择期脑手术的患者在服用和未服用阿司匹林情况下的再出血率。我们报告一例81岁女性患者，因择期开颅手术和脑转移瘤切除术入院。她出现右侧偏盲超过两周，磁共振成像（MRI）进一步检查显示左侧枕叶病变。为进行原发性心血管预防，患者被处方预防性低剂量阿司匹林100毫克。入院当天的血小板功能测试检测到高度异常的值。手术安排在第二天，阿司匹林的服用暂停。手术前一天早晨重复进行血小板功能测试。有趣的是，测试显示血小板功能高于正常水平20%。开颅手术和肿瘤切除按常规方式进行，术中未报告出血倾向增加。术后，右侧偏盲立即消退。术后24小时进行的MRI显示肿瘤完全切除，无任何再出血迹象。患者术后五天出院，无任何神经功能缺损。关于择期脑手术中抗血小板药物管理的文献有限且缺乏指南。如本病例及文献综述所证实，在某些经过风险和获益分层的情况下，可考虑在服用抗血小板药物的情况下进行择期开颅手术和肿瘤切除。需要更多数据和随机对照试验来证实这些发现。
