Delayed post-operative haemorrhage after carmustine wafer implantation

Implantation of carmustine wafers has been associated with increased operative site complications in some series, but post-operative haematoma is not routinely reported.

A retrospective audit of surgical site haematoma after tumour resection and insertion of carmustine wafers in two neurosurgical units in the UK (University Hospital of North Staffordshire, Stoke-on-Trent, March 2003 – July 2012; Wessex Neurological Centre, Southampton, October 2005 – January 2013) in 181 operations of 177 patients showed 8 (4.4%) patients. All presented in a delayed fashion on or after Day 2 post-operatively. In contrast, acute operative site haematoma was present in 4/491 (0.81%) of patients who underwent resection without gliadel wafer insertion.

In contrast to the expected timing of bleeding following intracranial tumour resection, all carmustine wafer patients who experienced haemorrhage presented in a delayed fashion on or after Day 2 post-operatively. The causative factors for universally delayed post-operative haematoma after carmustine wafer insertion are unclear and further studies are required to characterize this phenomenon¹