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
› Institutsangaben
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.



Publikationsverlauf

Eingereicht: 26. Mai 2020

Angenommen: 13. August 2020

Artikel online veröffentlicht:
22. Februar 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Fraioli MF, Marciani MG, Umana GE, Fraioli B. Anterior microsurgical approach to ventral lower cervical spine meningiomas: indications, surgical technique and long term outcome. Technol Cancer Res Treat 2014
  • 2 Fricia M, Umana GE, Scalia G. et al. Posttraumatic triple acute epidural hematomas: first report of bilateral synchronous epidural hematoma and a third delayed. World Neurosurg 2020; 133: 212-215
  • 3 Umana GE, Visocchi M, Scalia G. et al. Minimally invasive percutaneous anterior odontoid screw fixation: institutional experience with a simple and effective technique. J Neurosurg Sci 2020; (e-pub ahead of print) DOI: 10.23736/S0390-5616.20.04886-9.
  • 4 Umana GE, Cristaudo C, Scalia G. et al. Chronic epidural hematoma caused by traumatic intracranial pseudoaneurysm of the middle meningeal artery: review of the literature with a focus on this unique entity. World Neurosurg 2020; 136: 198-204
  • 5 Fridriksson S, Säveland H, Jakobsson KE. et al. Intraoperative complications in aneurysm surgery: a prospective national study. J Neurosurg 2002; 96 (03) 515-522
  • 6 Batjer H, Samson D. Intraoperative aneurysmal rupture: incidence, outcome, and suggestions for surgical management. Neurosurgery 1986; 18 (06) 701-707
  • 7 Sandalcioglu IE, Schoch B, Regel JP. et al. Does intraoperative aneurysm rupture influence outcome? Analysis of 169 patients. Clin Neurol Neurosurg 2004; 106 (02) 88-92
  • 8 Lin TK, Hsieh TC, Tsai HC, Lu YJ, Lin CL, Huang YC. Factors associated with poor outcome in patients with major intraoperative rupture of intracranial aneurysm. Acta Neurol Taiwan 2013; 22 (03) 106-111
  • 9 van Lindert EJ, Böcher-Schwarz HG, Perneczky A. The influence of surgical experience on the rate of intraoperative aneurysm rupture and its impact on aneurysm treatment outcome. Surg Neurol 2001; 56 (03) 151-156 , discussion 156–158
  • 10 Wong JM, Ziewacz JE, Ho AL. et al. Patterns in neurosurgical adverse events: open cerebrovascular neurosurgery. Neurosurg Focus 2012; 33 (05) E15
  • 11 Shander A. Financial and clinical outcomes associated with surgical bleeding complications. Surgery 2007; 142 (04) S20-S25
  • 12 Chandra RK, Conley DB, Haines III GK, Kern RC. Long-term effects of FloSeal packing after endoscopic sinus surgery. Am J Rhinol 2005; 19 (03) 240-243
  • 13 Hsu C-E, Lin T-K, Lee M-H. et al. The impact of surgical experience on major intraoperative aneurysm rupture and their consequences on outcome: a multivariate analysis of 538 microsurgical clipping cases. PLoS One 2016; 11 (03) e0151805
  • 14 Yasunaga H, Matsuyama Y, Ohe K. Japan Neurosurgical Society. Risk-adjusted analyses of the effects of hospital and surgeon volumes on postoperative complications and the modified Rankin scale after clipping of unruptured intracranial aneurysms in Japan. Neurol Med Chir (Tokyo) 2008; 48 (12) 531-538 , discussion 538
  • 15 Hattori N, Katayama Y, Abe T. Japan Neurosurgical Society. Case volume does not correlate with outcome after cerebral aneurysm clipping: a nationwide study in Japan. Neurol Med Chir (Tokyo) 2007; 47 (03) 95-100 , discussion 100–101
  • 16 Elijovich L, Higashida RT, Lawton MT, Duckwiler G, Giannotta S, Johnston SC. Cerebral Aneurysm Rerupture After Treatment (CARAT) Investigators. Predictors and outcomes of intraprocedural rupture in patients treated for ruptured intracranial aneurysms: the CARAT study. Stroke 2008; 39 (05) 1501-1506
  • 17 Benedetto N, Vannozzi R. Clip assisted use of gelatin-thrombin matrix sealant as a rescue procedure to treat a hidden arterial tear. Br J Neurosurg 2012; 26 (04) 568-569
  • 18 Echave M, Oyagüez I, Casado MA. Use of Floseal, a human gelatine-thrombin matrix sealant, in surgery: a systematic review. BMC Surg 2014; 14: 111