J Neurol Surg A Cent Eur Neurosurg 2022; 83(04): 383-387
DOI: 10.1055/s-0040-1720986
Case Report

Use of Gelatin-thrombin Hemostatic Matrix for Control of Ruptured Cerebral Aneurysm

1   Department of Neurosurgery, Cannizzaro Hospital, Catania, Italy
,
2   Department of Neurosurgery, National Specialist Hospital Garibaldi, Catania, Italy
,
Angelo Spitaleri
1   Department of Neurosurgery, Cannizzaro Hospital, Catania, Italy
,
Nicola Alberio
1   Department of Neurosurgery, Cannizzaro Hospital, Catania, Italy
,
Marco Fricia
1   Department of Neurosurgery, Cannizzaro Hospital, Catania, Italy
,
Santino Ottavio Tomasi
3   Department of Neurosurgery, Paracelsus Medical Private University, Salzburg, Salzburg, Austria
,
Giovanni Federico Nicoletti
2   Department of Neurosurgery, National Specialist Hospital Garibaldi, Catania, Italy
,
Salvatore Cicero
1   Department of Neurosurgery, Cannizzaro Hospital, Catania, Italy
› Author Affiliations
Funding None.

Abstract

Background The use of thrombin-based hemostatic agents (TBHAs) has become common practice in most neurosurgical procedures, both cranial and spinal.

Methods We present the case of a 40-year-old woman who was referred to our institution with intense headache and Fisher grade 3 subarachnoid hemorrhage (SAH) mainly at the level of the right sylvian fissure, caused by a 5.71-mm right middle cerebral artery (MCA) bifurcation aneurysm, with hourglass morphology and a bleb on the bottom. Cerebral angiography demonstrated aneurysm enlargement, compared with the prior angiographic computerized tomography scan.

Results A right pterional craniotomy was performed. After initial arachnoid dissection to get proximal vascular control, but before we obtained it, we witnessed profuse bleeding from the aneurysm. Floseal, a gelatin-thrombin matrix sealant, was sprayed over the breach of the aneurysm, and cottonoids were gently pressed with a self-retaining spatula, stopping the hemorrhage. After that, we obtained proximal control with an extradural clinoidectomy and temporary clipping of the right internal carotid artery (ICA) and MCA. Finally, aneurysm dissection and final clipping were performed with the application of two clips. The postoperative course was uneventful, and the patient was discharged on postoperative day 10.

Conclusion Intraoperative aneurysm rupture (IAR) is a dangerous event that carries great risks—even death. Proper use of TBHAs is a useful and safe way to stop the bleeding, take a deep breath, and achieve proximal vascular control. To the best of our knowledge, this is the first report of the use of TBHA during aneurysm clipping.



Publication History

Received: 26 May 2020

Accepted: 13 August 2020

Article published online:
22 February 2021

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