Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
J Neurosurg. 2011 Sep;115(3):576-83. doi: 10.3171/2011.3.JNS10881. Epub 2011 Apr 1.
The use of commercially available topical hemostatic adjuncts has increased the safety profile of surgery as a whole. Cranial surgery has also benefited from the development of numerous agents designed to permit more rapid achievement of hemostasis. Flowable topical hemostatic agents applied via syringe injection are now commonly employed in many neurosurgical procedures, including cranial surgery. Intravascular use of these strongly thrombogenic agents is contraindicated, but in certain settings, inadvertent intravascular administration can occur, resulting in vascular occlusion, thrombosis, and potential dissemination. To date, there have no reports detailing the presence and incidence of this complication.
The authors conducted a retrospective review of all cranial surgeries performed at Presbyterian University Hospital by members of the University of Pittsburgh Medical Center's Department of Neurological Surgery between 2007 and 2009. Cases complicated by vascular occlusion due to inadvertent intravascular administration of flowable topical hemostatic matrix (FTHM) were identified and analyzed.
Iatrogenic vascular occlusion induced by FTHM was identified in 5 (0.1%) of 3969 cranial surgery cases. None of these events occurred in 3318 supratentorial cases, whereas 5 cases of cerebral venous sinus occlusion occurred in 651 infratentorial cases (0.8%). The risk of accidental vessel occlusion was significantly associated with infratentorial surgery, and all events occurred in the transverse and/or sigmoid sinus. No episodes of inadvertent vascular occlusion occurred during endoscopic surgery. No cases of arterial occlusion were identified. Of the 5 patients with FTHM-related cerebral venous sinus occlusion, none developed long-term neurological sequelae referable to the event.
Inadvertent intravascular administration of FTHM is a rare complication associated with cranial surgery that occurs most commonly during infratentorial procedures around the transverse and/or sigmoid sinuses. Modifications in the choice of when to use an FTHM and the method of application may help prevent accidental venous sinus administration.
商业上可获得的局部止血辅助剂的使用提高了整个手术的安全性。许多旨在更快实现止血的药物的开发也使颅外科从中受益。通过注射器注射应用的可流动局部止血剂现在常用于许多神经外科手术中，包括颅外科。这些强血栓形成剂的血管内使用是禁忌的，但在某些情况下，可能会发生意外的血管内给药，导致血管闭塞、血栓形成和潜在的扩散。迄今为止，尚无详细描述这种并发症的存在和发生率的报道。
作者对 2007 年至 2009 年期间匹兹堡大学医学中心神经外科部门的成员在长老会大学医院进行的所有颅外科手术进行了回顾性审查。确定并分析了因可流动局部止血基质（FTHM）意外血管内给药引起的血管闭塞的病例。
在 3969 例颅外科手术中，有 5 例（0.1%）发生了由 FTHM 引起的医源性血管闭塞。在 3318 例幕上病例中，没有发生这些事件，而在 651 例幕下病例中，有 5 例脑静脉窦闭塞（0.8%）。意外血管闭塞的风险与幕下手术显著相关，所有事件均发生在横窦和/或乙状窦。在经内镜手术中没有发生无意血管闭塞的事件。没有发现动脉闭塞的病例。在与 FTHM 相关的脑静脉窦闭塞的 5 例患者中，没有 1 例因该事件发生长期神经后遗症。
FTHM 的意外血管内给药是颅外科手术的一种罕见并发症，最常见于横窦和/或乙状窦周围的幕下手术。改变使用 FTHM 的时机和应用方法可能有助于防止意外静脉窦给药。
