Iatrogenic cerebral venous sinus occlusion with flowable topical hemostatic matrix

Advanced Surgical Techniques for Dural Venous Sinus Repair: A Comprehensive Literature Review

The dural venous sinus (DVS) is a thin-walled blood channel composed of dura mater that is susceptible to injury during common neurosurgical approaches. DVS injuries are highly underreported, which is reflected by a lack of literature on the topic. Neurosurgeons should be familiar with appropriate techniques to successfully repair an injured DVS and prevent associated complications. This study presents a literature review on the surgical techniques for DVS repair after DVS injury during common neurosurgical approaches. The databases PubMed and Scopus were queried using the terms "cranial sinuses," "superior sagittal sinus," "transverse sinuses," "injury," and "surgery." A total of 117 articles underwent full-text review and were analyzed for surgical approach, craniotomy, lesion location, lesion characteristics, and surgical repair techniques. A literature review was performed, and a comprehensive summary is presented. Data from publications describing DVS lacerations related to pathological conditions (eg, meningioma) were excluded. A total of 9 techniques aiding with bleeding control, hemostasis, and sinus repair and reconstruction were identified, including compression, hemostatic agents, bipolar cautery, dural tenting and tack-up suturing, dural flap, direct suturing, autologous patch, venous bypass, and ligation. The advantages and drawbacks of each technique are described. Multiple options to treat DVS injuries are available to the neurosurgeon. Treatment type is based on anatomic location, complexity of the laceration, cardiovascular status, the presence of air embolism, and the dexterity and experience of the surgeon.

Two Cases of Cerebral Infarcts Caused by Topical Hemostatic Agent Embolism

ABSTRACT

Resorbable topical hemostatic agents are widely used in surgical procedures to control intraoperative bleeding. There have been multiple reports of complications from use of these agents, including pulmonary vasculature thromboembolism, cerebral venous sinus occlusion, and postoperative inflammatory mass lesions each containing the hemostatic agent. We report 2 cases of inadvertent intra-arterial embolization of hemostatic agent. Both cases followed elective surgical cervical spinal procedures, during which gelatin-based local hemostatic agents were used to control unanticipated bleeding. Postoperatively, both patients exhibited neurologic defects and were found to have infarcts of the brain. At autopsy, vertebrobasilar thromboemboli containing foreign material grossly and microscopically consistent with hemostatic matrix material were found in both cases. These are the first reports of hemostatic agent embolization resulting in cerebral infarcts and leading to death.

Clinical characteristics of cerebral venous thrombosis in a single center in Korea

OBJECTIVE

The purpose of this study is to investigate the clinical characteristics of cerebral venous thrombosis (CVT) in a single center in Korea.

METHODS

A total of 36 patients were diagnosed with CVT from August 2005 to May 2013. The patient data regarding age, sex, disease stage, pathogenesis, location, laboratory findings, radiological findings, and treatment modalities were retrospectively collected. The results were compared with those of previous studies in other countries.

RESULTS

The patient group comprised 21 men and 15 women with a mean age of 46.9 years (ranging from three months to 77 years). The most common cause was a prothrombotic condition (8 patients, 22.2%). Within the patient group, 13 patients (36.1%) had a hemorrhagic infarction, whereas 23 (63.9%) had a venous infarction without hemorrhage. By location, the incidence of hemorrhagic infarction was the highest in the group with a transverse and/or sigmoid sinus thrombosis (n=9); however, the proportion of hemorrhagic infarction was higher in the cortical venous thrombosis group (75%) and the deep venous thrombosis group (100%). By pathogenesis, the incidence of hemorrhagic infarction was the highest in the prothrombotic group (n=6), which was statistically significant (p=0.016).

CONCLUSION

According to this study, CVT was more prevalent in men, and the peak age group comprised patients in the sixth decade. The most common cause was a prothrombotic condition. This finding was comparable with reports from Europe or America, in which CVT was more common in younger women. Hemorrhagic infarction was more common in the prothrombotic group (p=0.016) than in the non-prothrombotic group in this study.