Blood Transfusion Guidelines in Skull Base Surgery: A Scoping Review
Document Type
Article
Publication Title
Journal of Clinical Neuroscience
Abstract
Objective: Consensus guidelines are lacking for the administration of blood product transfusions in adult skull base neurosurgery. This study aims to synthesize the current literature and provide preliminary evidence-based considerations for blood product transfusions in skull base surgery.
Methods: A scoping review was conducted using PubMed, Web of Science, and SCOPUS databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines.
Results: Eleven articles were included. Of the three studies reporting skull base surgery outcomes, greater mean age was correlated with a higher likelihood of transfusion. Pre-admission diagnoses of cardiovascular disease, diabetes, coagulopathy, anticoagulation, liver disease, stroke, and seizure were the most common comorbid diseases of transfused patients. Transfused patients had a greater range of hospital length of stay (15.5-19.9 days versus 4.9-8 days). One study comparing anemic versus non-anemic patients found a marked difference in the mean length of stay (4.6 versus 1.4 days, respectively) between their two patient groups. Additionally, this study found anemic patients to have a 3.4 % mortality rate while the non-anemic cohort had a 0.8 % mortality rate. The average volume of transfused blood in standard and transglabellar/subcranial approaches was 545 mL and 194 mL, respectively. Only one study proposed a hemoglobin threshold specific to skull base surgery for blood transfusion at 7-8 g/dL.
Conclusion: Based on our scoping review, a hemoglobin level of 7 g/dL (Level B, Class IIa) may represent a reasonable starting point to guide transfusions in skull base surgery, though prospective validation is warranted.
DOI
10.1016/j.jocn.2025.111522
Publication Date
7-28-2025
Keywords
Blood transfusion, Hemoglobin, Neurosurgery, Scoping review, Skull base surgery, Transfusion
ISSN
1532-2653
Recommended Citation
Gundlach C, Poulson TA, Bah M, Newsome-Cuby TR, Eraghi MM, Michel M, Nilchian P, Farid M, Azam F, AlDallal U, Anand S, O'Leary S, Barrie U, Aoun SG. Blood Transfusion Guidelines in Skull Base Surgery: A Scoping Review. Journal of Clinical Neuroscience. 2025; . doi: 10.1016/j.jocn.2025.111522.
