Background Major blood loss during neurosurgery can lead to several complications, including life-threatening hemodynamic instabilities. Studies addressing these complications in patients undergoing intracranial tumor surgery are limited. Materials and Methods During the study period, 456 patients who underwent elective craniotomy for brain tumor excision were categorized into four groups on the basis of estimated intraoperative blood volume loss: Group A (<20%), Group B (20-50%), Group C (>50-100%), and Group D (more than estimated blood volume). The occurrence of various perioperative complications was correlated with these groups to identify if there was any association with the amount of intraoperative blood loss. Results The average blood volume loss was 11% ± 5.3% in Group A, 29.8% ± 7.9% in Group B, 68.3% ± 13.5% in Group C, and 129.1% ± 23.9% in Group D. Variables identified as risk factors for intraoperative bleeding were female gender ( p < 0.001), hypertension ( p = 0.008), tumor size >5 cm ( p < 0.001), high-grade glioma ( p = 0.004), meningioma ( p < 0.001), mass effect ( p = 0.002), midline shift ( p = 0.014), highly vascular tumors documented on preoperative imaging ( p < 0.001), extended craniotomy approach ( p = 0.002), intraoperative colloids use >1,000 mL ( p < 0.001), intraoperative brain bulge ( p = 0.03), intraoperative appearance as highly vascular tumor ( p < 0.001), and duration of surgery >300 minutes ( p < 0.001). Conclusions Knowledge of these predictors may help anesthesiologists anticipate major blood loss during brain tumor surgery and be prepared to mitigate these complications to improve patient outcome.

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