Bone Wax in Neurosurgery: A Review

Area of Science:

• Neurosurgery
• Surgical Innovation

Background:

• Bone wax (BW) is a hemostatic agent with a long history, first used in the 18th century.
• Its use in neurosurgery was popularized by Sir Victor Horsley, though he is not its original inventor.
• Commercial BW formulations include beeswax, paraffin wax, and isopropyl palmitate.

Purpose of the Study:

• To review the historical use of bone wax (BW).
• To discuss the applications, efficacy, and complications of BW in surgical procedures.
• To explore the development of alternatives to traditional bone wax.

Main Methods:

• Historical literature review.
• Analysis of the composition and mechanism of action of bone wax.
• Examination of reported complications and alternative hemostatic agents.

Main Results:

• Bone wax functions primarily through mechanical tamponade.
• Despite being cost-effective, BW use is linked to complications like poor bone healing and infection.
• No current alternative fully replaces the utility of bone wax.

Conclusions:

• Bone wax remains a widely used, albeit imperfect, hemostatic agent in surgery.
• The development of safer and more effective alternatives is an ongoing area of research.
• Understanding BW's limitations is crucial for improving surgical hemostasis.