Published online Sep 28, 2015. doi: 10.4254/wjh.v7.i21.2352
Peer-review started: April 22, 2015
First decision: June 2, 2015
Revised: June 22, 2015
Accepted: August 30, 2015
Article in press: September 7, 2015
Published online: September 28, 2015
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.
Core tip: Liver cirrhosis is a major comorbid factor for surgical patients, including neurosurgery. We reviewed published articles in the field of neurosurgical procedures. For the high incidence of morbidity/mortality rate, in cirrhotic patients, procedures should be carefully assessed and managed aggressively toward the coagulopathy and nutritional status.