脑内转移存在肿瘤相关脑出血（ICH）的巨大风险。本研究旨在调查不同原发肿瘤部位脑转移瘤（BM）发生出血事件的风险，并评估手术肿瘤切除术的安全性和结果。对接受脑转移瘤切除术的患者的病历进行回顾性、单中心审查2016 年 1 月至 2017 年 12 月期间。将出血性 BM 患者与非出血性 BM 患者进行比较。收集并分析术前预测因素、围手术期管理和术后结果的数据。共有 229 名患者符合纳入标准。即使在调整混杂因素后，黑色素瘤转移与术前出血显着相关（p==0.001）。不良的临床状态（p = 0.001）、较大的肿瘤体积（p = 0.020）和不良的预后（p = 0.001）独立预测自发性出血。重要的是，术前使用抗凝药物与出血风险增加无关（p = 0.592）。停止血液稀释药物后，手术切除出血性骨髓不会显着影响术中失血量、手术持续时间或术后再出血风险（p > 0.096）。然而，瘤内出血与总生存率降低相关（p = 0.001）。本研究强调了 BM 患者抗凝治疗的安全性，并强调了暂时停止血液稀释药物治疗出血性 BM 患者时神经外科治疗的安全性。瘤内出血的存在会对生存产生负面影响，凸显了其对 BM 患者的预后意义。有必要对更大的队列进行进一步研究，以验证这些发现并阐明潜在机制。© 2024。作者。

Intracerebral metastases present a substantial risk of tumor-associated intracerebral hemorrhage (ICH). This study aimed to investigate the risk of hemorrhagic events in brain metastases (BM) from various primary tumor sites and evaluate the safety and outcomes of surgical tumor removal.A retrospective, single-center review of medical records was conducted for patients who underwent BM removal between January 2016 and December 2017. Patients with hemorrhagic BM were compared to those with non-hemorrhagic BM. Data on preoperative predictors, perioperative management, and postoperative outcomes were collected and analyzed.A total of 229 patients met the inclusion criteria. Melanoma metastases were significantly associated with preoperative hemorrhage, even after adjusting for confounding factors (p = 0.001). Poor clinical status (p = 0.001), larger tumor volume (p = 0.020), and unfavorable prognosis (p = 0.001) independently predicted spontaneous hemorrhage. Importantly, preoperative use of anticoagulant medications was not linked to increased hemorrhagic risk (p = 0.592). Surgical removal of hemorrhagic BM, following cessation of blood-thinning medication, did not significantly affect intraoperative blood loss, surgical duration, or postoperative rebleeding risk (p > 0.096). However, intra-tumoral hemorrhage was associated with reduced overall survival (p = 0.001).This study emphasizes the safety of anticoagulation in patients with BM and highlights the safety of neurosurgical treatment in patients with hemorrhagic BM when blood-thinning medication is temporarily paused. The presence of intra-tumoral hemorrhage negatively impacts survival, highlighting its prognostic significance in BM patients. Further research with larger cohorts is warranted to validate these findings and elucidate underlying mechanisms.© 2024. The Author(s).