Balloon compression technique in the management of persistent intraoperative intratumoral hemorrhage resulting from stereotactic biopsy: technical note.
BACKGROUND
Despite its proven safety, intraoperative intratumoral hemorrhage is an uncommon but serious complication of stereotactic brain biopsy.


OBJECTIVE
We describe the "balloon compression technique" that was used in the management of persistent intraoperative bleeding that could not be arrested by conventional methods of hemostasis.


METHODS
Between January 2001 and March 2009, of 184 image-guided stereotactic brain biopsy procedures, intraoperative intratumoral bleeding occurred in 12 cases (6.5%). In 3 of these 12 cases (1.6%), intraoperative hemorrhage was persistent. In these cases, after adjustment of the optimum length, a balloon catheter (Fogarty) was inserted through the cannula and inflated with a contrast agent. We observed the patient for 10 minutes by checking the position of the balloon with regular intervals, using a frozen C-arm fluoroscope to determine any significant changes in its initial position due to possible enlargement of the hematoma. The patient was also closely observed during this time.


RESULTS
Hemostasis was obtained immediately after the inflation of the balloon in all 3 cases. The patients tolerated the procedure well. During and after the procedure no complications related to the technique were observed. None of the cases required craniotomy for evacuation of the hematoma and to secure hemostasis.


CONCLUSIONS
Our preliminary results indicate that the balloon compression technique seems to be a safe, rapid, and effective stereotactic practice in the management of the persistent intraoperative intratumoral bleeding that could not be arrested by standard, conventional hemostatic methods.
Kutlay
Murat
M
Department of Neurosurgery, Haydarpaşa Training Hospital, Gülhane Military Medical Academy, Istanbul, Turkey.
Simşek
Hakan
H
Colak
Ahmet
A
Demircan
Mehmet Nusret
MN
D000328:Adult; D000368:Aged; D001254:Astrocytoma / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D021721:Balloon Occlusion / Q000295:instrumentation / Q000379:methods*; D001706:Biopsy / Q000009:adverse effects*; D001932:Brain Neoplasms / Q000098:blood supply / Q000473:pathology* / Q000503:physiopathology; D002404:Catheterization / Q000295:instrumentation / Q000379:methods; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D005910:Glioma / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000379:methods; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013238:Stereotaxic Techniques / Q000009:adverse effects*; D016896:Treatment Outcome; D055815:Young Adult