Biosurgical Hemostatic Agents in Neurosurgical Intracranial Procedures.
Intraoperative hemostasis during neurosurgical procedures is one of the most important aspects of intracranial surgery. Hemostasis is mandatory to keep a clean operative field and to prevent blood loss and postoperative hemorrhage. In neurosurgical practice, biosurgical hemostatic agents have proved to be extremely useful to complete the more classic use of electrocoagulation. During recent years, many biosurgical topical hemostatic agents were created. Although routinely used during neurosurgical procedures, there is still a great deal of confusion concerning optimal use of these products, because of the wide range of products, as absorbable topical agents, antifibrinolytics agents, fibrin sealants and hemostatic matrix, which perform their hemostatic action in different ways. The choice of the hemostatic agent and the strategy for local hemostasis are correlated with the neurosurgical approach, the source of bleeding, and the neurosurgeon's practice. In this study, the authors review all the different sources of bleeding during intracranial surgical approaches and analyze how to best choose the right topical hemostatic agent to stop bleeding, from the beginning of the surgical approach to the end of the extradural hemostasis after dural closure, along all the steps of the neurosurgical procedure.
Department of Neurosurgery, San Giovanni Addolorata Hospital, Rome, Italy.
Roberto
R
Gazzeri
Regional Service of Neurosurgery, School of Medicine, University of Murcia, Murcia, Spain.
Marcelo
M
Galarza
Department of Neurosurgery, San Giovanni Addolorata Hospital, Rome, Italy.
Giorgio
G
Callovini
Department of Neurosurgery, and Spinal Surgery, Ruppiner Kliniken Neuruppin, Germany.
Alex
A
Alfieri
D002483:Cellulose, Oxidized; D004338:Drug Combinations; D005340:Fibrinogen; D006490:Hemostatics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D020300:Intracranial Hemorrhages / Q000188:drug therapy / Q000517:prevention & control; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D013917:Thrombin
D002483:Cellulose, Oxidized; D004338:Drug Combinations; D006490:Hemostatics; C518955:TachoSil; C013695:Surgicel; D005340:Fibrinogen; D013917:Thrombin