Benedetto Nicola, Vannozzi Riccardo
Neurosurgical Department, AOUP, Pisa, Italy.
Br J Neurosurg. 2012 Aug;26(4):568-9. doi: 10.3109/02688697.2011.639410. Epub 2011 Dec 15.
Major intracranial arteries can be injured during tumor removal. Surgeons routinely manage this event by using either microvascular direct repair, by-pass of the wounded segment or the placement of a sutureless device. These procedures, however, are not always possible due to artery brittleness, deep operating field, vascular configuration, or restricted viewing field. In this particular case, we illustrate an example of innovative use of gelatin-thrombin matrix sealant used to repair a hidden tear of pericallosal-callosomarginal bifurcation. A 49-year-old man underwent resection of a recurrent left frontal glioma. During an attempt to remove a firmly attached portion of the tumor, a tear occured in the pericallosal-callosomarginal bifurcation. The wall defect was repaired with a temporary vascular clip placed on the pericallosal artery and gelatin-thrombin matrix sealant sprayed over the tear. An intraoperative indocyanine videoangiography showed patency of both the pericallosal and callosomarginal arteries. Gelatin-thrombin matrix sealant is useful to control bleeding from an artery when the viewing field is restricted. In some cases, however, blood outflow must first be reduced in order to allow clot formation.
在肿瘤切除过程中，主要颅内动脉可能会受到损伤。外科医生通常通过微血管直接修复、受伤节段搭桥或放置无缝合装置来处理这种情况。然而，由于动脉脆性、手术视野深、血管结构或视野受限，这些操作并非总是可行。在这个特殊病例中，我们展示了一个创新使用明胶 - 凝血酶基质密封剂修复胼周 - 胼缘分叉处隐匿性撕裂的例子。一名49岁男性接受了复发性左额叶胶质瘤切除术。在试图切除肿瘤牢固附着部分时，胼周 - 胼缘分叉处出现了撕裂。通过在胼周动脉上放置临时血管夹并在撕裂处喷洒明胶 - 凝血酶基质密封剂来修复壁缺损。术中吲哚菁绿视频血管造影显示胼周动脉和胼缘动脉均通畅。当视野受限时，明胶 - 凝血酶基质密封剂有助于控制动脉出血。然而，在某些情况下，必须首先减少血液流出以形成血凝块。
