Local hemostatic matrix for endoscope-assisted removal of intracerebral hemorrhage is safe and effective.
OBJECTIVE
Minimally invasive endoscope-assisted (MIE) evacuation of spontaneous intracerebral hemorrhage (ICH) is simple and effective, but the limited working space may hinder meticulous hemostasis and might lead to rebleeding. Management of intraoperative hemorrhage is therefore a critical issue of this study. This study presents experience in the treatment of patients with various types of ICH by MIE evacuation followed by direct local injection of FloSeal Hemostatic Matrix (Baxter Healthcare Corp, Fremont, CA, USA) for hemostasis.


METHODS
The retrospective nonrandomized clinical and radiology-based analysis enrolled 42 patients treated with MIE evacuation of ICH followed by direct local injection of FloSeal Hemostatic Matrix. Rebleeding, morbidity, and mortality were the primary endpoints. The percentage of hematoma evacuated was calculated from the pre- and postoperative brain computed tomography (CT) scans. Extended Glasgow Outcome Scale (GOSE) was evaluated at 6 months postoperatively.


RESULTS
Forty-two ICH patients were included in this study, among these, 23 patients were putaminal hemorrhage, 16 were thalamic ICH, and the other three were subcortical type. Surgery-related mortality was 2.4%. The average percentage of hematoma evacuated was 80.8%, and the rebleeding rate was 4.8%. The mean operative time was 102.7 minutes and the average blood loss was 84.9 mL. The mean postoperative GOSE score was 4.55 at 6-months' follow-up.


CONCLUSIONS
This study shows that local application of FloSeal Hemostatic Matrix is safe and effective for hemostasis during MIE evacuation of ICH. In our experience, this shortens the operation time, especially in cases with intraoperative bleeding. A large, prospective, randomized trial is needed to confirm the findings.
Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Hui-Tzung
HT
Luh
Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Abel Po-Hao
AP
Huang
Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Shih-Hung
SH
Yang
Department of Neurosurgery, Chang-Hau Christian Hospital, Chang-Hau, Taiwan.
Chien-Ming
CM
Chen
Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan.
Der-Yang
DY
Cho
Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan.
Chun-Chung
CC
Chen
Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Lu-Ting
LT
Kuo
Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan.
Chieh-Hsun
CH
Li
Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Kuo-Chuan
KC
Wang
Department of Surgery, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan.
Wei-Lung
WL
Tseng
Department of Neurosurgery, Chang-Hau Christian Hospital, Chang-Hau, Taiwan.
Ming-Tai
MT
Hsing
Biomechanics and Medical Application Laboratory, Department of Mechanical Engineering, National Chiao Tung University, Taiwan.
Bing-Shiang
BS
Yang
Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Dar-Ming
DM
Lai
Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; Institute of Medical Device and Imaging, National Taiwan University, Taipei, Taiwan. Electronic address: jctsai@ntu.edu.tw.
Jui-Chang
JC
Tsai
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000401:mortality / Q000601:surgery; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000008:administration & dosage*; D015600:Glasgow Coma Scale; D006406:Hematoma / Q000209:etiology / Q000601:surgery*; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000009:adverse effects / Q000379:methods*; D061646:Operative Time; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
C411004:FloSeal Matrix; D006490:Hemostatics
Endoscope-assisted surgery; FloSeal Hemostatic Matrix; Local hemostatic agent; Minimally invasive surgery; Spontaneous intracerebral hemorrhage