Bleeding in Neurosurgery
Bleeding in Neurosurgery
Different types of bleeding may be encountered:
1. Bone cutting and diffuse capillary and epidural venous bleeding is characterised as oozing
2. High-pressured arterial bleeding can take the form of pulsatile bleeding.
In modern neurosurgery using minimally invasive microsurgical approaches, blood loss does not occur on a grand scale and is less of an issue than with other types of surgery.
Even small amounts of bleeding can be troublesome when magnified during microsurgery. This problem is exacerbated by the growing use of anticoagulant and antiplatelet drugs, eg Aspirin
Therefore, the ideal haemostasis agent needs to work quickly, even in coagulopathic patients, without swelling too much or leaving any bulky excess.
Treatments
-Surgicel - absorbable material made of oxidised cellulose that needs to be held in contact with the lesion to initiate coagulation. Works mostly. By Ethicon
Drawbacks : There is a chance that bleeding might restart once patch is removed. Very bulky
-For bone bleeding – bone wax (beeswax+paraffin)
Drawbacks : foreigh substance, interferes with bone fusion
-FLOSEAL(http://www.floseal.com/us/) = cross-linked gelatine granules + topical human thrombin by Baxter
-reabsorbed as part of healing process
-works withinh 2-3 minutes
-does not work on patients with Afibrinogenaemia (absence of fibrin in blood)
Novoseven
Novoseven (recombinant activated factor VII)- was used in pediatric neurosurgical procedures.
Clinical trails - http://clinicaltrials.gov/ct2/show/NCT00128050?term=novoseven&rank=1
Procedure category and ICD-9-CM code | Number | SE \1 | Number | SE \1 | Number | SE \1 | Number | SE \1 | Number | SE \1 | All procedures \2 | 47,962 | 5,101 | 1,605 | 402 | 14,740 | 1,656 | 13,788 | 1,504 | 17,829 | 1,870 | Operations on the nervous system 01-05 | 1,251 | 187 | 180 | 49 | 295 | 49 | 353 | 56 | 422 | 67 | Spinal tap 03.31 | 307 | 50 |
Different types of bleeding may be encountered:
1. Bone cutting and diffuse capillary and epidural venous bleeding is characterised as oozing
2. High-pressured arterial bleeding can take the form of pulsatile bleeding.
In modern neurosurgery using minimally invasive microsurgical approaches, blood loss does not occur on a grand scale and is less of an issue than with other types of surgery.
Even small amounts of bleeding can be troublesome when magnified during microsurgery. This problem is exacerbated by the growing use of anticoagulant and antiplatelet drugs, eg Aspirin
Therefore, the ideal haemostasis agent needs to work quickly, even in coagulopathic patients, without swelling too much or leaving any bulky excess.
Treatments
-Surgicel - absorbable material made of oxidised cellulose that needs to be held in contact with the lesion to initiate coagulation. Works mostly. By Ethicon
Drawbacks : There is a chance that bleeding might restart once patch is removed. Very bulky
-For bone bleeding – bone wax (beeswax+paraffin)
Drawbacks : foreigh substance, interferes with bone fusion
-FLOSEAL(http://www.floseal.com/us/) = cross-linked gelatine granules + topical human thrombin by Baxter
-reabsorbed as part of healing process
-works withinh 2-3 minutes
-does not work on patients with Afibrinogenaemia (absence of fibrin in blood)
Novoseven
Novoseven (recombinant activated factor VII)- was used in pediatric neurosurgical procedures.
Clinical trails - http://clinicaltrials.gov/ct2/show/NCT00128050?term=novoseven&rank=1
Procedure category and ICD-9-CM code | Number | SE \1 | Number | SE \1 | Number | SE \1 | Number | SE \1 | Number | SE \1 | All procedures \2 | 47,962 | 5,101 | 1,605 | 402 | 14,740 | 1,656 | 13,788 | 1,504 | 17,829 | 1,870 | Operations on the nervous system 01-05 | 1,251 | 187 | 180 | 49 | 295 | 49 | 353 | 56 | 422 | 67 | Spinal tap 03.31 | 307 | 50 |