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YAMAGUCHI I, KANEMATSU Y, SHIMADA K, NAKAJIMA K, MIYAMOTO T, SOGABE S, SHIKATA E, ISHIHARA M, AZUMI M, KAGEYAMA A, TAKAGI Y. Gelatin–thrombin Hemostatic Matrix-related Cyst Formation after Cerebral Hematoma Evacuation: A Report of Two Cases. NMC Case Rep J 2021; 8:719-725. [PMID: 35079539 PMCID: PMC8769470 DOI: 10.2176/nmccrj.cr.2021-0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/10/2021] [Indexed: 11/20/2022] Open
Abstract
The gelatin–thrombin matrix, Floseal, is an excellent novel hemostatic agent that is used in various surgical fields. Thrombin is a serine protease, and the conversion of prothrombin to thrombin is an essential step in the coagulation cascade. However, thrombin can induce blood–brain barrier (BBB) disruption and vasogenic brain edema. This report describes two cases of gelatin–thrombin matrix-related cyst formation after cerebral hematoma evacuation. An 82-year-old man with a gelatin–thrombin matrix-related cyst was treated by cyst drainage and fenestration to the lateral ventricle. Histological evaluation of the cyst wall showed a gelatin–thrombin matrix reserve, marked infiltration of inflammatory cells, and foam cell accumulation. In addition, an 85-year-old woman with a gelatin–thrombin matrix-related cyst was treated with steroids and responded well. In both cases, the post-treatment course was uneventful. Cyst shrinkage and no recurrence were observed. The gelatin–thrombin matrix can cause cyst formation with brain edema. This is the first report demonstrating the cyst wall pathology and the steroid responsivity on cyst shrinkage. The mechanism of cyst formation is thought to be thrombin-induced BBB disruption. Excess gelatin–thrombin matrix should be carefully removed from the surgical beds, particularly those having a blinded space from the neurosurgical microscope.
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Affiliation(s)
- Izumi YAMAGUCHI
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Yasuhisa KANEMATSU
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Kenji SHIMADA
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Kohei NAKAJIMA
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Takeshi MIYAMOTO
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Shu SOGABE
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Eiji SHIKATA
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Manabu ISHIHARA
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Mai AZUMI
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Ayato KAGEYAMA
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Yasushi TAKAGI
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
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An anti-inflammatory gelatin hemostatic agent with biodegradable polyurethane nanoparticles for vulnerable brain tissue. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 121:111799. [PMID: 33579446 DOI: 10.1016/j.msec.2020.111799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/15/2020] [Accepted: 12/05/2020] [Indexed: 11/23/2022]
Abstract
Hemostasis plays a fundamental and critical role in all surgical procedures. However, the currently used topical hemostatic agents may at times undesirably induce inflammation, infection, and foreign body reaction and hamper the healing process. This may be serious in the central nervous system (CNS), especially for some neurosurgical diseases which have ongoing inflammation causing secondary brain injury. This study was aimed to develop a hemostatic agent with anti-inflammatory property by incorporating carboxyl-functionalized biodegradable polyurethane nanoparticles (PU NPs) and to evaluate its functionality using a rat neurosurgical model. PU NPs are specially-designed anti-inflammatory nanoparticles and absorbed by a commercially available hemostatic gelatin powder (Spongostan™). Then, the gelatin was implanted to the injured rat cortex and released anti-inflammatory PU NPs. The time to hemostasis, the cerebral edema formation, and the brain's immune responses were examined. The outcomes showed that PU NP-contained gelatin attenuated the brain edema, suppressed the gene expression levels of pro-inflammatory M1 biomarkers (e.g., IL-1β level to be about 25%), elevated the gene expression levels of anti-inflammatory M2 biomarkers (e.g., IL-10 level to be about 220%), and reduced the activation of inflammatory cells in the implanted site, compared with the conventional gelatin. Moreover, PU NP-contained gelatin increased the gene expression level of neurotrophic factor BDNF by nearly 3-folds. We concluded that the PU NP-contained hemostatic agents are anti-inflammatory with neuroprotective potential in vivo. This new hemostatic agent will be useful for surgery involving vulnerable tissue or organ (e.g., CNS) and also for diseases such as stroke, traumatic brain injury, and neurodegenerative diseases.
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Hemostatic Thrombin-Gelatin Matrix-Related Intracranial Cyst Formation. World Neurosurg 2019; 126:475-480. [DOI: 10.1016/j.wneu.2019.03.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 03/03/2019] [Accepted: 03/04/2019] [Indexed: 11/24/2022]
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Gazzeri R, Galarza M, Conti C, De Bonis C. Incidence of thromboembolic events after use of gelatin-thrombin-based hemostatic matrix during intracranial tumor surgery. Neurosurg Rev 2017; 41:303-310. [DOI: 10.1007/s10143-017-0856-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 03/27/2017] [Accepted: 04/13/2017] [Indexed: 01/22/2023]
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Barroeta JE, Lhospital E, Smith E, Ko EM. Cytologic findings following intraoperative use of FlosealR
hemostatic matrix: A potential diagnostic pitfall in fluid aspiration cytology. Diagn Cytopathol 2016; 44:1117-1119. [DOI: 10.1002/dc.23566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/29/2016] [Accepted: 08/04/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Julieta E. Barroeta
- Department of Pathology; Cooper University Hospital, Cooper Medical School of Rowan University; Camden New Jersey
| | - Elliott Lhospital
- Department of Pathology; Pennsylvania Hospital, University of Pennsylvania Health System; Philadelphia Pennsylvania
| | - Eugene Smith
- Department of Pathology; Pennsylvania Hospital, University of Pennsylvania Health System; Philadelphia Pennsylvania
| | - Emily M. Ko
- Department of Obstetrics and Gynecology; Pennsylvania Hospital, University of Pennsylvania Health System; Philadelphia Pennsylvania
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