title: Safety and efficacy of microporous polysaccharide hemospheres in neurosurgery.
abstract: BACKGROUND
  Effective hemostasis is mandatory for brain tumor surgery. Microporous polysaccharide hemosphere (MPH) powder, a white powder compounded from potato starch, was recently introduced for surgical and emergency application.
  
  
  OBJECTIVE
  To evaluate the safety and efficacy of MPHs in brain tumor surgery.
  
  
  METHODS
  Thirty-three patients (mean age, 58 years; range, 22-84 years) underwent microsurgical brain tumor resection. Final hemostasis was performed by topical application of MPHs, video recorded, and subsequently analyzed. Blood samples were taken before surgery, before application of hemospheres, and postoperatively. Volume measurements of the tumor, resection cavity, and postoperative hematoma were done on magnetic resonance imaging and computed tomography scans. Clinical examinations focused on neurological outcome, complications, and allergic reactions.
  
  
  RESULTS
  Effective hemostasis was achieved by exclusive use of MPHs in 32 patients. In 1 patient, a single arterial bleeding underwent additional bipolar electrocauterization. Mean operative time was 156.8 minutes (range, 60-235 minutes). Hemostasis with MPHs required 57 seconds (mean; range, 8-202 seconds). Subjective neurosurgeons' ranking of the hemostasis effect indicated excellent satisfaction. For the first 3 months, there was no hemospheres-related postoperative neurological worsening, no signs of allergic reaction, and no embolic complications. Early postoperative and 3-month follow-up magnetic resonance imaging and computed tomography scans excluded any expansive bleeding complication. As early as postoperative day 1, MPHs were no longer detected. There was no tumor mimicking contrast enhancement.
  
  
  CONCLUSIONS
  In neurosurgery, MPHs allow fast and effective minimally invasive hemostasis. In this small case series, no adverse reactions were found.
authors.affiliation: Neurochirurgische Klinik, Universitaetsmedizin, Johannes Gutenberg-Universitaet, Mainz, Germany.
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Tschan
authors.forename: Meike
authors.initials: M
authors.lastname: Nie
authors.forename: Eike
authors.initials: E
authors.lastname: Schwandt
authors.forename: Joachim
authors.initials: J
authors.lastname: Oertel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000601:surgery*; D005260:Female; D006488:Hemostasis, Surgical / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D011134:Polysaccharides / Q000627:therapeutic use*; D016062:Porosity; D055815:Young Adult
chemical_list: D011134:Polysaccharides