Emergency Surgery for Brain Tumors: Institutional Experience and Strategic Decision-making in the Era of Structured Work-hour Management.

BACKGROUND

Emergency surgery for brain tumors is regarded as a life-saving intervention, but in contemporary neuro-oncological practice it may also serve diagnostic, stabilizing, and treatment-enabling roles.

METHODS

We retrospectively reviewed consecutive patients who underwent emergency surgery for brain tumors at a single institution between January 2020 and December 2025.

RESULTS

Among 352 brain tumor operations, 59 cases (16.8%) met the study definition of emergency surgery. The frequency of emergency surgery varied by tumor type, being highest in primary central nervous system lymphoma (11/18, 61.1%), followed by brain metastases (25/74, 33.8%), hemangioblastoma (2/7, 28.6%), glioma (15/83, 18.1%), pituitary neuroendocrine tumor (1/15, 6.7%), and meningioma (5/106, 4.7%). Emergency cases were stratified into four operational categories: life-saving surgery, malignant oncological emergency surgery, intentional delayed surgery after stabilization, and semi-urgent surgery. Tumor resection was performed in 42 patients (71.2%) and biopsy was performed in 17 (28.8%); all primary central nervous system lymphoma cases underwent diagnostic biopsy with intraoperative rapid pathology. Regarding operative timing, 34 procedures (57.6%) were completed within the 08:00-17:00 time frame, 17 (28.8%) started within the 08:00-17:00 time frame but extended beyond 17:00, and eight (13.6%) started at or after 17:00. Median preoperative and discharge modified Rankin Scale scores were both 3, with improvement in 21 patients, no change in 29, worsening in 7, and in-hospital death in two. Time to treatment initiation was evaluable in 41 malignant tumor cases requiring subsequent tumor-specific therapy, and differed according to tumor type.

CONCLUSIONS

Capacity-aware triage may help balance neurological urgency, tumor-specific therapeutic goals, preoperative stabilization, patient safety, and surgical quality under structured work-hour management.