A consultant anesthetist should see all craniotomy patients preoperatively. Elderly patients (> 70 years) and patients on multiple medications should routinely also seen by consultant internist, to optimize the general medical condition and medications. At our institution, patients with a known heart condition are referred to cardiologist for cardiac ultrasound and ECG stress test. Patients with a past hematological history are referred to a consultant hematologist. Aspirin, dipyridamole and clopidogrel are stopped at least 10 days prior to surgery and when on anticoagulation, the INR should be below 1.5. All patients receive compressive stockings the day before surgery and keep them until fully mobilized. Postoperatively, the patients are observed in the recovery for 3–6 h, whereafter they are transferred to a level 2 bed. After a craniotomy for a supratentorial tumor, the patients are generally observed for 24 h. For infratentorial tumors, the length of observation is minimum 48 h Low-molecularweight heparin is given the first postoperative day. The patients are mobilized either in the afternoon at the day of surgery or on the first postoperative day.

First-time craniotomies with primary resection were performed in 2,073 cases, 483 cases were reoperations with repeated resection, and 74 cases were open biopsies. Thus, the incidence of first-time craniotomy for a brain tumor was 12.8/100,000 inhabitants per year and for a repeat resection 3.0/100,000 inhabitants per year.

The surgical mortality, defined as death within 30 days of surgery, was 2.3 % (n = 60). In 21 cases, the cause of death was postoperative hematomas (35.0 %). In the remaining patients, the cause of death was either tumor progression (35.0 %), infectious diseases (13.3 %), postoperative edema and subsequent herniation (6.7 %), and other causes in 10 % (Table 17.2). Using multivariate Cox regression analyses, age > 60 (Odds ratio (OR) 1.84, 95 % CI (1.05, 3.22), p < 0.05) and biopsy compared to resection (OR 4.67, 95 % CI (1.80, 12.14) p < 0.01) were shown to be significantly associated with increased surgical mortality (Table 17.3).