Staged cranial resection of a left parietal high-grade glioma following intraoperative hemodynamic instability: a case report.

Unplanned staged resection for primary intra-axial tumors is rarely described in adults. A 54-year-old man with a left parietal high-grade glioma underwent decompressive craniectomy with attempted cytoreduction; an intraoperative hypertensive crisis triggered refractory venous hemorrhage and progressive cerebral edema, forcing the procedure to stop. He recovered neurologically (GCS 15) and returned 85 days later for a second-stage left parietal lobectomy using neuronavigation and sodium fluorescein-enhanced visualization, gross total resection, no complications. In high-grade glioma, hemodynamic instability need not preclude a complete resection; staging the procedure after physiological recovery appears to be a safe route when the initial operation cannot continue.