title: Use of a thrombin-gelatin haemostatic matrix in endoscopic endonasal extended approaches: technical note.
abstract: OBJECTIVE
  The management of intradural bleeding during extended endoscopic endonasal surgery is challenging. This technical note describes the use of a biological haemostatic agent which could be useful when other established strategies and materials are not effective.
  
  
  METHODS
  From January 2004 to January 2008, 65 consecutive patients underwent extended endoscopic endonasal interventions. Of these, 29 procedures required the application of a thrombin-gelatin haemostatic matrix. We reviewed the patients' operative records to determine the source, type of bleeding and haemostatic strategy.
  
  
  RESULTS
  We analysed bleedings from the venous sinuses, arteries, tumour bed and internal carotid artery and observed complete haemostasis immediately after application of FloSeal. The matrix was useful for both oozing and focal haemorrhage and effective even for high-flow bleeding. Only bleeding from an internal carotid artery tear required a second application.
  
  
  CONCLUSIONS
  The thrombin-gelatin matrix could represent a valuable tool when other haemostatic strategies are ineffective or suboptimal. It is safe and biocompatible when compared with haemostatic agents currently in use.
authors.affiliation: Department of Neurological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Via Pansini 5, Naples, Italy. paolo.cappabianca@unina.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Cappabianca
authors.forename: Felice
authors.initials: F
authors.lastname: Esposito
authors.forename: Isabella
authors.initials: I
authors.lastname: Esposito
authors.forename: Luigi Maria
authors.initials: LM
authors.lastname: Cavallo
authors.forename: Carlo Antonio
authors.initials: CA
authors.lastname: Leone
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery; D003397:Craniopharyngioma / Q000473:pathology / Q000601:surgery; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use*; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology / Q000601:surgery; D008579:Meningioma / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009296:Nasal Cavity / Q000098:blood supply / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery; D019106:Postoperative Hemorrhage / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D019292:Skull Base Neoplasms / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome
chemical_list: C411004:FloSeal Matrix