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Acta Neurochir (2011) 153:148155 DOI 10.1007/s00701-010-0762-y
CLINICAL ARTICLE
Hemostatic matrix sealant in neurosurgery: a clinical and imaging study
Roberto Gazzeri & Marcelo Galarza &
Massimiliano Neroni & Alex Alfieri & Marco Giordano
Received: 10 June 2010 /Accepted: 30 July 2010 /Published online: 12 August 2010 # Springer-Verlag 2010
AbstractObject The aim of this study was to investigate prospectively the efficacy and safety of Floseal hemostatic matrix.
Methods A total of 214 patients (87 males, 127 females; mean age 56.2 years) undergoing cranial (71.4%), craniospinal (0.9%), and spinal (27.5%) procedures with the use of gelatin thrombin hemostatic matrix (Floseal) were included in this prospective study. The indications for its use, surgical techniques, time to bleeding control, and associated complications were recorded.
Results Effective hemostasis, defined as cessation of bleeding, was achieved no later than 3 min after topical agent application in all patients except in 11 cases, in which
the hemostatic application was repeated. Rebleeding was disclosed in four patients 1 day after initial surgery. In one case, an intracerebral abscess developed after a malignant glioma removal. No other patient developed allergic reactions or local or systemic complications associated with the hemostatic sealant.
Conclusion In this study, matrix hemostatic sealant helped to control operative bleeding in cranial and spinal surgery, reducing damage to the surrounding healthy nervous tissue while shortening surgical timing. Other than safe, the immediate hemostatic effect is an advantage in the settings of refractory bleeding.
Keywords Intracerebral hemorrhage . Spontaneous hematoma . Hemostatic sealant . Cranial hemostasis . Spinal hemostasis . Floseal
Introduction
Adequate hemostasis in cranial and spinal surgery is of paramount importance in a neurosurgeon daily practice. Generalized ooze bleeding from the surgical walls cavity, usually coming from surface vessels of the dura mater or nervous tissue, may be bothersome, and it can usually be controlled with additional bipolar cautery or additional use of topical hemostatic agents. Nevertheless, thermal and mechanical coagulation may show disadvantages in eloquent areas or even properly controlling bleeding.
Although bipolar cautery may arrest bleeding from the operative field, this method bear the risk of healthy nervous tissue destruction, with deleterious neurological sequelae. In addition, a variety of hemostatic agents, such as peroxide, fibrin glue, among others, are used by neurosurgeons depending on the type, source, and