College of Medicine, Gulf Medical University, Ajman, United Arab Emirates.
Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA.
World Neurosurg. 2023 Oct;178:241-259.e3. doi: 10.1016/j.wneu.2023.08.030. Epub 2023 Aug 14.
Hemostasis is crucial in preventing hemorrhage during cranial neurosurgical procedures and maintaining visualization of the surgical field. There is significant variation in the availability of hemostatic methods across different settings and hemostatic techniques are being continuously developed over the decades of practicing neurosurgery. The aim of this article is to provide an outline of the potential methods to achieve hemostasis based on the sequential operative anatomy of a cranial operation.
A systematic review was conducted following the PRISMA guidelines. The PubMed database was searched from inception of the database to July 18, 2023. A total of 64 studies were identified fulfilling predefined inclusion criteria, and the risk of bias was assessed using the Joanna Briggs Institute checklists.
Seventy-one hemostatic agents, techniques, tools, and devices were identified, which were then categorized according to the operative phase for which they are indicated. Nine operative anatomic targets were addressed in the sequence in which they are involved during a cranial procedure. For each anatomic target, the following number of hemostatic techniques/agents were identified: 11 for scalp, 3 for periosteum, 10 for skull bone, 11 for dura mater, 9 for venous sinuses, 5 for arteries, 6 for veins, 12 for brain parenchyma, and 4 for cerebral ventricles.
Depending on the phase of the surgery and the anatomic structure involved, the selection of the appropriate hemostatic method is determined by the source of bleeding. Surgeon awareness of all the potential techniques that can be applied to achieve hemostasis is paramount, especially when faced with operative nuances and difficult-to-control bleeding during cranial neurosurgical procedures.
止血在颅脑神经外科手术中至关重要，可防止出血并保持手术视野清晰。不同环境中可用的止血方法存在显著差异，并且在神经外科手术的几十年中，止血技术不断得到发展。本文旨在根据颅脑手术的连续手术解剖学，提供实现止血的潜在方法概述。
按照 PRISMA 指南进行系统综述。从数据库建立之初到 2023 年 7 月 18 日，在 PubMed 数据库中进行了搜索。确定了符合预定义纳入标准的 64 项研究，并使用 Joanna Briggs 研究所清单评估了偏倚风险。
确定了 71 种止血剂、技术、工具和设备，然后根据其适应证的手术阶段进行分类。九个手术解剖学目标按照在颅脑手术中涉及的顺序进行处理。对于每个解剖学目标，确定了以下数量的止血技术/剂：头皮 11 种、骨膜 3 种、颅骨 10 种、硬脑膜 11 种、静脉窦 9 种、动脉 5 种、静脉 6 种、脑实质 12 种和脑室 4 种。
根据手术阶段和涉及的解剖结构，选择适当的止血方法取决于出血源。外科医生对所有潜在的止血技术都有充分的了解，这一点至关重要，尤其是在面对颅脑神经外科手术中的手术细微差别和难以控制的出血时。
