Hovis Gabrielle E A, Davies Jordan, Lockwood Joseph, Hsu Frank P K
Department of Neurosurgery, University of California, Irvine, Orange, California.
Department of Neurosurgery, Tulane University, New Orleans, Louisiana.
J Neurosurg Case Lessons. 2025 Jan 20;9(3). doi: 10.3171/CASE24607.
Intravascular injection of liquid adhesive hemostats is a rare but serious complication that can result in cerebral thromboembolism.
A 64-year-old female underwent orbitozygomatic craniotomy for posterior communicating artery aneurysm clipping with the routine use of a flowable hemostatic agent during extradural dissection. After placement of the aneurysm clip, flow was confirmed through the parent vessel and nearby branches. On postoperative day 1, the patient was found to have superficial middle cerebral vein thrombosis with retrograde embolization and subsequent hemorrhagic infarction of the temporal lobe. Eight prior cases of intracranial infarction or hemorrhage secondary to thrombosis with intravascular liquid adhesive were identified. With a craniotomy approach, the transverse and sigmoid sinuses were the most common sites of thrombosis, and the vertebral and basilar arteries had the highest incidence of thrombosis after cervical fusion.
Intravascular injection of liquid adhesive agents can result in cerebral venous thrombosis, typically of a dural venous sinus. This may present following retrograde embolization, which has not previously been reported. The choice of hemostat, surgical approach, nearby vasculature, and anatomical variations should be carefully considered in the operative management of neurosurgical patients. https://thejns.org/doi/10.3171/CASE24607.
血管内注射液体止血剂是一种罕见但严重的并发症，可导致脑血栓栓塞。
一名64岁女性因后交通动脉瘤夹闭术接受眶颧开颅手术，在硬膜外剥离过程中常规使用了可流动止血剂。放置动脉瘤夹后，确认血流通过母血管和附近分支。术后第1天，发现患者患有大脑中浅静脉血栓形成伴逆行栓塞，随后出现颞叶出血性梗死。此前已确定8例血管内液体粘合剂导致血栓形成继发颅内梗死或出血的病例。采用开颅手术时，横窦和乙状窦是最常见的血栓形成部位，颈椎融合术后椎动脉和基底动脉血栓形成的发生率最高。
血管内注射液体粘合剂可导致脑静脉血栓形成，通常为硬脑膜静脉窦血栓形成。这可能在逆行栓塞后出现，此前尚未见报道。在神经外科患者的手术管理中，应仔细考虑止血剂的选择、手术入路、附近血管系统和解剖变异。https://thejns.org/doi/10.3171/CASE24607
