Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Sep 28, 2015; 7(21): 2352-2357
Published online Sep 28, 2015. doi: 10.4254/wjh.v7.i21.2352
Neurosurgical procedures in patients with liver cirrhosis: A review
Ching-Chang Chen, Yin-Cheng Huang, Chun-Nan Yeh
Ching-Chang Chen, Yin-Cheng Huang, Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan
Ching-Chang Chen, Yin-Cheng Huang, Chun-Nan Yeh, Department of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
Chun-Nan Yeh, Department of General Surgery, Chang Gung Memorial Hospital, Linkouand, Taoyuan 333, Taiwan
Author contributions: Chen CC and Huang YC contributed equally as 1st authors; Huang YC and Yeh CN contributed equally for corresponding authorship; Chen CC and Huang YC contributed to the drafting of this manuscript; Huang YC and Yeh CN revised the manuscript and co-correspond to this review article.
Conflict-of-interest statement: All the authors declare no conflicts of interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is
Correspondence to: Yin-Cheng Huang, MD, Department of Neurosurgery, Chang Gung Memorial Hospital, Chaiyi, No. 6, West Sec. Chiapu Rd, Putzu city, Chiayi county, Taoyuan City 333, Taiwan.
Telephone: +886-5-3621000-2854 Fax: +886-5-3623002
Received: April 21, 2015
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.

Keywords: Neurosurgery, Liver cirrhosis, Traumatic brain injury, Brain tumor, Spine surgery, Complications, Surgical risks, Spontaneous intracranial hemorrhage

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.