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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Iatrogenic cerebral venous sinus occlusion with flowable topical hemostatic matrix
Richard H Singleton1, Brian T Jankowitz, Daniel A Wecht
1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
Journal of Neurosurgery
|April 5, 2011
Summary
Flowable topical hemostatic matrix (FTHM) can cause rare vascular occlusions during cranial surgery. These events, primarily venous sinus occlusions, are linked to infratentorial procedures and typically resolve without long-term effects.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Surgical Adjuncts
Background:
- Topical hemostatic agents improve surgical safety, with flowable agents commonly used in cranial procedures.
- Intravascular administration of these thrombogenic agents is contraindicated but can lead to complications.
- Previous literature lacks reports on the incidence of inadvertent intravascular administration of flowable topical hemostatic matrix (FTHM).
Purpose of the Study:
- To determine the incidence and characteristics of vascular occlusion caused by inadvertent intravascular administration of FTHM during cranial surgery.
Main Methods:
- A retrospective review of cranial surgeries performed between 2007 and 2009.
- Identification and analysis of cases with vascular occlusion due to inadvertent FTHM administration.
Main Results:
- Five cases (0.1%) of iatrogenic vascular occlusion by FTHM were identified in 3969 cranial surgeries.
- All 5 events occurred in infratentorial cases (0.8%), specifically in the transverse and/or sigmoid sinuses.
- No arterial occlusions or long-term neurological sequelae were observed.
Conclusions:
- Inadvertent intravascular FTHM administration is a rare cranial surgery complication, predominantly occurring in infratentorial procedures involving venous sinuses.
- Preventive strategies may involve careful selection and application of FTHM to avoid accidental venous sinus administration.
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