Authors: Vassilieva A et al.
Source: Journal of Neurosurgical Anesthesiology. Published May 22, 2026.
Summary:
This prospective observational study examined how often hyperlactatemia occurs during elective brain tumor craniotomy, what factors are associated with it, and whether it predicts worse short-term outcomes.
The authors studied 450 patients undergoing elective craniotomy for brain tumor surgery. Arterial lactate was measured every hour from the first surgical incision through 6 hours after surgery. Hyperlactatemia was defined as at least one lactate measurement of 2.2 mmol/L or higher.
Hyperlactatemia was very common, occurring in 66% of patients. However, the important finding was that hyperlactatemia was not associated with worse short-term clinical outcomes. The authors found no association between perioperative hyperlactatemia and change in neurological disability at 30 days, measured by the modified Rankin Scale. They also found no association with length of hospital stay, new neurological deficits at discharge, days alive and out of the hospital at 30 days, or 30-day mortality.
The study identified several factors independently associated with hyperlactatemia. These included higher perioperative glucose levels, higher preoperative glucocorticoid dose, malignant central nervous system tumor type, and noradrenaline dose.
Clinical importance:
This article is useful for anesthesia providers caring for neurosurgical patients because elevated lactate during tumor craniotomy can be concerning. In many clinical settings, lactate elevation raises concern for poor perfusion, shock, hypoxia, or worse prognosis. However, in this elective brain tumor craniotomy population, hyperlactatemia was common and did not appear to predict worse short-term outcomes.
The findings suggest that lactate elevation during these cases may often reflect metabolic and treatment-related factors rather than tissue hypoperfusion or impending clinical deterioration. Glucocorticoid exposure, glucose levels, tumor biology, and vasoactive medication use may all contribute.
Bottom line:
Perioperative hyperlactatemia is common during elective brain tumor craniotomy, occurring in about two-thirds of patients. In this study, it was not associated with worse short-term neurological or clinical outcomes. Anesthesia providers should still evaluate elevated lactate carefully, but this study suggests that isolated hyperlactatemia during elective tumor craniotomy may not automatically indicate poor prognosis.
Thank you to the Journal of Neurosurgical Anesthesiology for publishing this important study on perioperative hyperlactatemia during elective brain tumor craniotomy.