# Incidence, risk factors, and clinical implications of postoperative blood in or near the resection cavity after glioma surgery

## TL;DR

This study examines the frequency and impact of postoperative blood in or near the resection cavity after glioma surgery, finding that small hematomas are common but do not significantly affect quality of life.

## Contribution

The study provides new insights into the incidence and risk factors of postoperative blood accumulation in glioma patients, focusing on non-reoperation cases.

## Key findings

- Postoperative blood is common, with 63% intradural and 73% extradural blood observed in MRI scans.
- Intradural blood volume is linked to tumor size, intraoperative blood loss, and extent of resection.
- Extradural blood volume is associated with younger age and larger tumor size, but not with quality of life.

## Abstract

Postoperative hematomas that require reoperation are a serious, but uncommon complication to glioma surgery. However, smaller blood volumes are frequently observed, but their clinical significance is less known.

What are the incidence rates, risk factors, and patient-reported outcomes of all measurable blood in or near the resection cavity on postoperative MRI in diffuse glioma patients?

We manually segmented intradural and extradural blood from early postoperative MRI of 292 diffuse glioma resections. Potential associations between blood volume and tumor characteristics, demographics, and perioperative factors were explored using non-parametric methods. The assessed outcomes were generic and disease-specific patient-reported HRQoL.

Out of the 292 MRI scans included, 184 (63%) had intradural blood, and 212 (73%) had extradural blood in or near the resection cavity. The median blood volumes were 0.4 mL and 3.0 mL, respectively. Intradural blood volume was associated with tumor volume, intraoperative blood loss, and EOR. Extradural blood volume was associated with age and tumor volume. Greater intradural blood volume was associated with less headache and cognitive improvement, but not after adjustments for tumor volume.

Postoperative blood on early postoperative MRI is common. Intradural blood volumes tend to be larger in patients with larger tumors, more intraoperative blood loss, or undergoing subtotal resections. Extradural blood volumes tend to be larger in younger patients with larger tumors. Postoperative blood in or near the resection cavity that does not require reoperation does not seem to affect HRQoL in diffuse glioma patients.

•Hematomas are common on early postoperative MRI after glioma surgery.•Hematoma volume is associated with intraoperative blood loss, tumor size, and age.•Small postoperative hematomas do not seem to affect quality of life.

Hematomas are common on early postoperative MRI after glioma surgery.

Hematoma volume is associated with intraoperative blood loss, tumor size, and age.

Small postoperative hematomas do not seem to affect quality of life.