Managing Fibrinolysis and Hemorrhage During an Awake Craniotomy for Tumor Resection: A Case Report.

High-grade gliomas, including glioblastoma multiforme, represent some of the most prevalent and aggressive malignant brain tumors. Awake craniotomy is preferred for resecting tumors involving eloquent areas of the brain (motor, language, and executive function). Hyperfibrinolysis during these surgeries is rare, though hemorrhage is not uncommon. We report the management of hyperfibrinolytic coagulopathy and hemorrhage in a 59-year-old man undergoing an awake craniotomy for the World Health Organization (WHO) grade IV glioblastoma. This case underscores the importance of goal-directed coagulation management, using point-of-care viscoelastic testing and time-critical intervention such as tranexamic acid and fibrinogen concentrate when treating hemorrhagic complications during tumor resection.