{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T07:01:17Z","timestamp":1790319677712,"version":"4.1.0"},"reference-count":52,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n Emergency craniotomy for traumatic intracranial hemorrhage is time-dependent, yet surgery may be futile when profound thrombocytopenia and coagulopathy prevent hemostasis and severe brain swelling is already present.<\/jats:p>\n <\/jats:sec>\n \n Case Description:<\/jats:title>\n A young adult man with traumatic intracranial hemorrhage rapidly deteriorated to coma (Glasgow coma scale-3). Admission laboratories showed white blood cell count 72,300\/\u00b5L, platelet count 12,000\/\u00b5L, and prothrombin time-international normalized ratio 1.59, raising concern for an underlying hematologic disorder, including acute leukemia, with coagulopathy. Head computed tomography demonstrated a large frontal intraparenchymal hemorrhage with traumatic subarachnoid hemorrhage, intraventricular extension, and imaging features consistent with severe diffuse brain swelling. After intubation, emergency craniotomy was undertaken with perioperative transfusion of red blood cells, fresh frozen plasma, and platelets. Diffuse bleeding and marked brain swelling prevented durable hemostasis, and the patient died.<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n When neurotrauma meets hematologic catastrophe, the decision to operate should incorporate both neurologic salvageability and the realistic probability of achieving usable hemostasis within the available time. Early estimation of attainable platelet correction, together with rapid coagulation assessment including fibrinogen when available, parallel hematology support, and a damage-control operative plan with pre-specified stopping rules may help frame surgery as a time-limited trial rather than a binary choice.<\/jats:p>\n <\/jats:sec>","DOI":"10.25259\/sni_336_2026","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T06:50:21Z","timestamp":1790319021000},"page":"536","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Decision-making for emergency craniotomy in traumatic intracranial hemorrhage with severe thrombocytopenia and coagulopathy in a patient with suspected acute leukemia: A case-based review"],"prefix":"10.25259","volume":"17","author":[{"given":"Kosei","family":"Goto","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Fukujukai Adachi Tobu Hospital, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuo","family":"Kutsuna","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Fukujukai Adachi Tobu Hospital, Tokyo, Japan"},{"name":"Department of Stress and Invasiveness Control, Toho University School of Medicine, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kotaro","family":"Makita","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Fukujukai Adachi Tobu Hospital, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuto","family":"Nishihara","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Fukujukai Adachi Tobu Hospital, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"10.25259\/SNI_336_2026\/ref-1","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1097\/ACO.0b013e328325a6be","article-title":"The role of thromboelastometry and recombinant factor VIIa in trauma","volume":"22","author":"Bartal","year":"2009","journal-title":"Curr Opin Anaesthesiol"},{"key":"10.25259\/SNI_336_2026\/ref-2","doi-asserted-by":"crossref","first-page":"e225","DOI":"10.3346\/jkms.2024.39.e225","article-title":"Case-based review standards (CABARET): Considerations for authors, reviewers, and editors","volume":"39","author":"Benlidayi","year":"2024","journal-title":"J Korean Med Sci"},{"key":"10.25259\/SNI_336_2026\/ref-3","doi-asserted-by":"crossref","first-page":"e96","DOI":"10.1016\/j.wneu.2022.10.059","article-title":"Decompressive hemicraniectomies as a damage control approach for multilobar firearm projectile injuries: A single-center experience","volume":"169","author":"Bertani","year":"2023","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_336_2026\/ref-4","first-page":"348","article-title":"Recombinant factor VIIa for the correction of coagulopathy before emergent craniotomy in blunt trauma patients","volume":"68","author":"Brown","year":"2010","journal-title":"J Trauma"},{"key":"10.25259\/SNI_336_2026\/ref-5","doi-asserted-by":"crossref","first-page":"S25","DOI":"10.1227\/01.NEU.0000210365.36914.E3","article-title":"Surgical management of traumatic parenchymal lesions","volume":"58","author":"Bullock","year":"2006","journal-title":"Neurosurgery"},{"key":"10.25259\/SNI_336_2026\/ref-6","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1227\/NEU.0000000000001432","article-title":"Guidelines for the management of severe traumatic brain injury, fourth edition","volume":"80","author":"Carney","year":"2017","journal-title":"Neurosurgery"},{"key":"10.25259\/SNI_336_2026\/ref-7","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1186\/1741-7015-10-97","article-title":"Intracranial hemorrhage in adult patients with hematological malignancies","volume":"10","author":"Chen","year":"2012","journal-title":"BMC Med"},{"key":"10.25259\/SNI_336_2026\/ref-8","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1093\/annonc\/mdn755","article-title":"Prediction of fatal intracranial hemorrhage in patients with acute myeloid leukemia","volume":"20","author":"Chen","year":"2009","journal-title":"Ann Oncol"},{"key":"10.25259\/SNI_336_2026\/ref-9","doi-asserted-by":"crossref","first-page":"268","DOI":"10.3171\/2011.4.JNS101784","article-title":"Clinical outcome of leukemia patients with intracranial hemorrhage. Clinical article","volume":"115","author":"Chern","year":"2011","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_336_2026\/ref-10","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1007\/s00277-020-04298-7","article-title":"Thrombocytopenia and the effect of platelet transfusions on the occurrence of intracranial hemorrhage in patients with acute leukemia-a nested case-control study","volume":"100","author":"Cornelissen","year":"2021","journal-title":"Ann Hematol"},{"key":"10.25259\/SNI_336_2026\/ref-11","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1111\/bjh.14423","article-title":"Guidelines for the use of platelet transfusions","volume":"176","author":"Estcourt","year":"2017","journal-title":"Br J Haematol"},{"key":"10.25259\/SNI_336_2026\/ref-12","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.jclinepi.2013.08.003","article-title":"The CARE guidelines: Consensus-based clinical case report guideline development","volume":"67","author":"Gagnier","year":"2014","journal-title":"J Clin Epidemiol"},{"key":"10.25259\/SNI_336_2026\/ref-13","doi-asserted-by":"crossref","first-page":"2829","DOI":"10.1182\/bloodadvances.2021004789","article-title":"Characteristics and predictors of early hospital deaths in newly diagnosed APL: A 13-year population-wide study","volume":"5","author":"Gill","year":"2021","journal-title":"Blood Adv"},{"key":"10.25259\/SNI_336_2026\/ref-14","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1111\/bjh.17018","article-title":"Early intracranial haemorrhages in acute promyelocytic leukaemia: Analysis of neuroradiological and clinico-biological parameters","volume":"193","author":"Gurnari","year":"2021","journal-title":"Br J Haematol"},{"key":"10.25259\/SNI_336_2026\/ref-15","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s00701-007-1475-8","article-title":"Coagulation disorders after traumatic brain injury","volume":"150","author":"Harhangi","year":"2008","journal-title":"Acta Neurochir (Wien)"},{"key":"10.25259\/SNI_336_2026\/ref-16","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1016\/j.jointm.2023.12.008","article-title":"Outcomes of intracranial hemorrhage in critically ill patients with acute leukemia: Results of a retrospective cohort study","volume":"4","author":"Herault","year":"2024","journal-title":"J Intensive Med"},{"key":"10.25259\/SNI_336_2026\/ref-17","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1007\/s12185-016-2072-5","article-title":"Co-occurrence of hyperleukocytosis and elevated fibrin-fibrinogen degradation product levels is a risk factor for early intracranial hemorrhage in patients with de novo acute leukemia","volume":"104","author":"Ichikawa","year":"2016","journal-title":"Int J Hematol"},{"key":"10.25259\/SNI_336_2026\/ref-18","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1227\/NEU.0000000000000685","article-title":"Use of prothrombin complex concentrate as an adjunct to fresh frozen plasma shortens time to craniotomy in traumatic brain injury patients","volume":"76","author":"Joseph","year":"2015","journal-title":"Neurosurgery"},{"key":"10.25259\/SNI_336_2026\/ref-19","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s40981-018-0146-5","article-title":"Preoperative elevated FDP may predict severe intraoperative hypotension after dural opening during decompressive craniectomy of traumatic brain injury","volume":"4","author":"Kamiutsuri","year":"2018","journal-title":"JA Clin Rep"},{"key":"10.25259\/SNI_336_2026\/ref-20","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1038\/sj.leu.2404148","article-title":"Risk score model for fatal intracranial hemorrhage in acute leukemia","volume":"20","author":"Kim","year":"2006","journal-title":"Leukemia"},{"key":"10.25259\/SNI_336_2026\/ref-21","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1111\/ejh.13718","article-title":"Intracranial hemorrhage in newly diagnosed non-promyelocytic acute myeloid leukemia patients admitted for intensive induction chemotherapy","volume":"108","author":"Koschade","year":"2022","journal-title":"Eur J Haematol"},{"key":"10.25259\/SNI_336_2026\/ref-22","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1080\/10428194.2026.2624658","article-title":"Risk prediction model and survival analysis of adult patients with intracranial hemorrhage in acute leukemia","volume":"67","author":"Li","year":"2026","journal-title":"Leuk Lymphoma"},{"key":"10.25259\/SNI_336_2026\/ref-23","doi-asserted-by":"crossref","first-page":"101505","DOI":"10.1016\/j.neuchi.2023.101505","article-title":"Neuro damage control: Current concept and civilian applications","volume":"69","author":"Manet","year":"2023","journal-title":"Neurochirurgie"},{"key":"10.25259\/SNI_336_2026\/ref-24","doi-asserted-by":"crossref","first-page":"3303","DOI":"10.1111\/trf.16703","article-title":"Risk factors for intracranial hemorrhage in adults with acute leukemia","volume":"61","author":"Maze","year":"2021","journal-title":"Transfusion"},{"key":"10.25259\/SNI_336_2026\/ref-25","article-title":"Guidelines for the use of Blood Products","author":"Ministry of Health. Labour and Welfare","year":"2017"},{"key":"10.25259\/SNI_336_2026\/ref-26","doi-asserted-by":"crossref","first-page":"108699","DOI":"10.1016\/j.clineuro.2024.108699","article-title":"Coagulopathy at admission in traumatic brain injury and its association with hematoma progression: A systematic review and meta-analysis of 2411 patients","volume":"249","author":"Mohammadzadeh","year":"2025","journal-title":"Clin Neurol Neurosurg"},{"key":"10.25259\/SNI_336_2026\/ref-27","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1097\/SLA.0000000000006640","article-title":"Early cold-stored platelet transfusion following traumatic brain injury: A randomized clinical trial","volume":"281","author":"Neal","year":"2025","journal-title":"Ann Surg"},{"key":"10.25259\/SNI_336_2026\/ref-28","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1111\/trf.15621","article-title":"Clinical outcomes and transfusion management following intracranial hemorrhage in patients with acute leukemia","volume":"60","author":"Nixon","year":"2020","journal-title":"Transfusion"},{"key":"10.25259\/SNI_336_2026\/ref-29","first-page":"15","article-title":"Intracranial hemorrhage in patients with hematologic disorders: Prevalence and predictive factors","volume":"99","author":"Owattanapanich","year":"2016","journal-title":"J Med Assoc Thai"},{"key":"10.25259\/SNI_336_2026\/ref-30","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1001\/jama.2011.1413","article-title":"Time-limited trials near the end of life","volume":"306","author":"Quill","year":"2011","journal-title":"JAMA"},{"key":"10.25259\/SNI_336_2026\/ref-31","doi-asserted-by":"crossref","first-page":"e15","DOI":"10.1016\/j.wneu.2020.06.091","article-title":"Outcomes and clinical characteristics of intracranial hemorrhage in patients with hematologic malignancies: A systematic literature review","volume":"144","author":"Raghavan","year":"2020","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_336_2026\/ref-32","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1007\/s12028-022-01639-4","article-title":"Dynamic changes of hemostasis in patients with traumatic brain injury undergoing craniotomy: Association with in-hospital mortality","volume":"38","author":"Rimaitis","year":"2023","journal-title":"Neurocrit Care"},{"key":"10.25259\/SNI_336_2026\/ref-33","doi-asserted-by":"crossref","first-page":"e922879","DOI":"10.12659\/MSM.922879","article-title":"Implementation of thromboelastometry for coagulation management in isolated traumatic brain injury patients undergoing craniotomy","volume":"26","author":"Rimaitis","year":"2020","journal-title":"Med Sci Monit"},{"key":"10.25259\/SNI_336_2026\/ref-34","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1016\/j.injury.2004.03.006","article-title":"Damage control neurosurgery","volume":"35","author":"Rosenfeld","year":"2004","journal-title":"Injury"},{"key":"10.25259\/SNI_336_2026\/ref-35","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1186\/s13054-023-04327-7","article-title":"The European guideline on management of major bleeding and coagulopathy following trauma: Sixth edition","volume":"27","author":"Rossaint","year":"2023","journal-title":"Crit Care"},{"key":"10.25259\/SNI_336_2026\/ref-36","doi-asserted-by":"crossref","first-page":"e82","DOI":"10.1016\/j.wneu.2019.01.005","article-title":"The evolving concept of damage control in neurotrauma: Application of military protocols in civilian settings with limited resources","volume":"125","author":"Rubiano","year":"2019","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_336_2026\/ref-37","doi-asserted-by":"crossref","first-page":"1630","DOI":"10.1182\/blood-2019-01-894980","article-title":"Management of acute promyelocytic leukemia: Updated recommendations from an expert panel of the European LeukemiaNet","volume":"133","author":"Sanz","year":"2019","journal-title":"Blood"},{"key":"10.25259\/SNI_336_2026\/ref-38","first-page":"881","article-title":"The impact of platelets on the progression of traumatic intracranial hemorrhage","volume":"68","author":"Schn\u00fcriger","year":"2010","journal-title":"J Trauma"},{"key":"10.25259\/SNI_336_2026\/ref-39","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2176\/nmc.52.1","article-title":"Guidelines for the management of severe head injury, 2nd edition, guidelines from the guidelines committee on the management of severe head injury, the Japan society of neurotraumatology","volume":"52","author":"Shigemori","year":"2012","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"10.25259\/SNI_336_2026\/ref-40","doi-asserted-by":"crossref","first-page":"118","DOI":"10.4103\/ajns.AJNS_278_17","article-title":"Markers of fibrinolysis in Indian patients with isolated head trauma","volume":"14","author":"Sikka","year":"2019","journal-title":"Asian J Neurosurg"},{"key":"10.25259\/SNI_336_2026\/ref-41","first-page":"544","article-title":"Guideline for the use of platelet transfusion concentrates based on scientific evidence: Update 2019","volume":"65","author":"Takami","year":"2019","journal-title":"Japanese J Transf Cell Ther"},{"key":"10.25259\/SNI_336_2026\/ref-42","doi-asserted-by":"crossref","first-page":"e19","DOI":"10.1016\/j.wneu.2022.07.029","article-title":"Impact of thrombocytopenia on preoperative hematoma expansion for acute traumatic subdural hematoma","volume":"167","author":"Thakkar","year":"2022","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_336_2026\/ref-43","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1007\/s13760-021-01786-z","article-title":"Emergent surgical evacuation of traumatic intracranial hematoma in patients with preoperative thrombocytopenia: Surgical risk and early outcome","volume":"123","author":"Tsuneoka","year":"2023","journal-title":"Acta Neurol Belg"},{"key":"10.25259\/SNI_336_2026\/ref-44","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1007\/s00701-016-3043-6","article-title":"Progressive hemorrhagic injury in patients with traumatic intracerebral hemorrhage: Characteristics, risk factors and impact on management","volume":"159","author":"Wan","year":"2017","journal-title":"Acta Neurochir (Wien)"},{"key":"10.25259\/SNI_336_2026\/ref-45","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1179\/1743132813Y.0000000187","article-title":"Uncorrected traumatic coagulopathy is associated with severe brain swelling during decompressive surgery to evacuate a supratentorial intradural mass lesion in patients with traumatic brain injury","volume":"35","author":"Wang","year":"2013","journal-title":"Neurol Res"},{"key":"10.25259\/SNI_336_2026\/ref-46","doi-asserted-by":"crossref","first-page":"e1061","DOI":"10.1016\/j.wneu.2019.07.079","article-title":"Subdural hematoma in patients with hematologic malignancies: An outcome analysis and examination of risk factors of operative and nonoperative management","volume":"130","author":"Wright","year":"2019","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_336_2026\/ref-47","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s13049-017-0471-0","article-title":"Prognostic value of coagulation tests for in-hospital mortality in patients with traumatic brain injury","volume":"26","author":"Yuan","year":"2018","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"10.25259\/SNI_336_2026\/ref-48","doi-asserted-by":"crossref","first-page":"2617","DOI":"10.1007\/s00277-022-04982-w","article-title":"Clinical characteristics and prognostic factors in intracranial hemorrhage patients with hematological diseases","volume":"101","author":"Zhang","year":"2022","journal-title":"Ann Hematol"},{"key":"10.25259\/SNI_336_2026\/ref-49","doi-asserted-by":"crossref","first-page":"2550067","DOI":"10.1080\/16078454.2025.2550067","article-title":"Association between CDSS score and 30-day mortality in nonAPL acute leukemia patients with intracranial hemorrhage: A cohort study","volume":"30","author":"Zhang","year":"2025","journal-title":"Hematology"},{"key":"10.25259\/SNI_336_2026\/ref-50","doi-asserted-by":"crossref","first-page":"e21","DOI":"10.1016\/j.wneu.2019.09.024","article-title":"Low-dose, early fresh frozen plasma transfusion therapy after severe trauma brain injury: A clinical, prospective, randomized, controlled study","volume":"132","author":"Zhang","year":"2019","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_336_2026\/ref-51","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/j.wneu.2017.04.140","article-title":"Increased transfusion of fresh frozen plasma is associated with mortality or worse functional outcomes after severe traumatic brain injury: A retrospective study","volume":"104","author":"Zhang","year":"2017","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_336_2026\/ref-52","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.jocn.2017.06.058","article-title":"Risk factors and clinical characteristics of non-promyelocytic acute myeloid leukemia of intracerebral hemorrhage: A single center study in China","volume":"44","author":"Zhang","year":"2017","journal-title":"J Clin Neurosci"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/decision-making-for-emergency-craniotomy-in-traumatic-intracranial-hemorrhage-with-severe-thrombocytopenia-and-coagulopathy-in-a-patient-with-suspected-acute-leukemia-a-case-based-review\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/decision-making-for-emergency-craniotomy-in-traumatic-intracranial-hemorrhage-with-severe-thrombocytopenia-and-coagulopathy-in-a-patient-with-suspected-acute-leukemia-a-case-based-review\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T06:50:27Z","timestamp":1790319027000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/decision-making-for-emergency-craniotomy-in-traumatic-intracranial-hemorrhage-with-severe-thrombocytopenia-and-coagulopathy-in-a-patient-with-suspected-acute-leukemia-a-case-based-review\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,25]]},"references-count":52,"alternative-id":["10.25259\/SNI_336_2026"],"URL":"https:\/\/doi.org\/10.25259\/sni_336_2026","relation":{},"ISSN":["2152-7806","2229-5097"],"issn-type":[{"value":"2152-7806","type":"electronic"},{"value":"2229-5097","type":"print"}],"subject":[],"published":{"date-parts":[[2026,9,25]]},"article-number":"536"}}