bleeding

HaemoCer,ahemostaticagentforbleedingcontrolin

Neurosurgery

LuisBromleyColomaMD,PhD

DepartmentofNeurosurgeryHospitalGuillermoAlmenaraLimaPeru

USEOFHEMOSTATICAGENTSINNEUROSURGERY

Correspondence

DrLuisBromleyColomaChiefDepartmentofNeurosurgery

AvGrau800LaVictoriaLimaPeru

Phone+513242983

E-mail********************

Abstract

Profubleedingduringvascular,tumoralortraumaticinterventioninbrainor

spinearecontrolledusingdifferenthaemostaticproductsandtechniques.

Unfortunatelysometimesthebleedingcannotbecontrolledbecauthebleeding

sitecannotbefullyvisualizedwhichoftenresultsinpost-surgicalbleeding

necessitatingre-intervention.

Weprentanalternativetechniquetocontrolbleedingusingaplantbad

polysaccharidehaemostat(Haemocer).

Followingeffectivebleedingcontrolwedidnotobrveanyadverreaction.

Keywords

Haemocer,Bleeding,haemostat,polysaccharide,hemostat,plantbad.

Introduction

Haemostasisisthehumanbody'srespontocontrolbloodlosswhenthereis

surgicalprocedureshemostasisisvital,andthe

surgeonneverproceedstocompletethesurgeryuntilbloodlossiscontrolled

rolledbloodlossmayresultinrious

complicationsandincreadpatientmorbidity.

Haemostasisasanaturalphysiologicalprocessandinvolvesacoordinatedeffort

betweenplateletsandnumerousbloodclottingproteins(orfactors),resultingin

theformationofabloodclottostopthebleeding,repairthedamageandfinally

dissolvetheclot.

Haemostasishasveraldefinedphas,initiallythe"vascularconstriction

pha"whichoccursdelayingbleeding,theprimaryphainwherethe

hemostaticplugortheplaquetaryplugiscreated,thecondaryphaor

coagulationandthefibrinolysispha.

Haemostaticagentsudduringsurgeriesareactivelyinvolvedinvariousphas

ofhaemostasiscontributingtotherepairofvasculardamagethatcaus

bleeding.

Theuofcontacthemostasisagentsinneurosurgeryallowsustoobtainbetter

resultsinthesurgicaltreatmentofpatientswithvascular,tumoralandtraumatic

pathologiesinthebrain,ticagentsare

applieddirectlytothebleedingsiteoftenobtainingeitheraphysical,chemicalor

combinedaction.

Technique

Amongsttheagentswehaveudaregelatinspongemadefrombovineskin,

oxygenatedregeneratedcellulo,naturalfibersandpolymers,biomoleculeslike

vegetalpolysaccharides,thrombinobtainedfromthedeepflexorbovinetendon,

fibrinogenconcentrates,fibrinogenwiththrombincombinations,eof

antageswehavenoted

inoursurgicalpracticearethatwhenapplieddirectlytothebleedingarea,some

productsbeinglowinPHarebactericidal,withminimaltissuereaction,while

othersactivatecoagulationfactorslikeVIIthusfacilitatingtheinitiationofthe

extrinsicpathwayorshortcoagulationpathand/orfactorIIIthatpromotes

plateletaggregation.

Amongthedisadvantagescertainproductshavearethattheycantake10weeks

tobereabsorbed,theycangenerategranulomaandforeignbodyreactions,they

canpromotescarringoradhesionstoothertissues,itissometimesnecessaryto

removeincaofinfection,theycangeneratepressureoveradjacentstructures,

theycanproduceanedema,burningorencapsulation,theymustnotbeudon

contaminatedwoundsbecautheycanintensifytheinfectionfactors,theycan

produceemboli,theyarenotavailableworldwide,therecanbeariskofviral

nhaemostaticagentsarecontraindicatedinneurological

proceduralapplications.

ThehemostaticagentHaemoCerisanabsorbablepolysaccharidepolymer

ntactwiththebloodHaemoCeraccelerates

thenaturalcoagulationcascadebyarapiddehydrationofthebloodandtherapid

aggregationofplatelets,redbloodcellsandclottingproteinsatthebleedingsite.

Furtherarobustgelledmatrixisformedatthewoundsiteprovidingamechanical

terialisrapidlydegradednaturallywith24-

erhasminimalcontraindicationsandisavailabletobeudin

Neurosurgery.

Conclusions

WehavebeenusingHaemocertechnologysincelastyear(2012)withpositive

bergreaterthan50casweud

HaemoCerintraoperativelyinpatientswithcerebralvasculardialike

aneurysmsand/orAVMs(Arteriovenousmalformation),inpatientswithbrain

tumorpathologieitherbenign(meningiomasorpituitarytumors)ormalignant

(gliomasandparticularlymultiformeglioblastoma),incranialbraintrauma

patients(subduralandepiduralhematomas)andinpathologiesofthespine

column(fractures)andspinalcord(tumors)mainly.

UsingHaemoCerinoperatedpatientsbeingdiagnodwithBrainBenign

Tumor:weapplytheproductinthesurgicalbedinordertogenerate

hemostasisinareaswherethetumorhasbeenimplantedinthebrain

parenchymaand/ortheduraand/orfalxcerebriobtainingquickand

eringthatinthecasthebraintumorisoutside

theparenchymalbutitsstronglyattachedtoitbyalargequantityofblood

veslsthatarefeedingthetumor,atthemomentofrectingthetumor,it

bleedsduringtheintratumordecompressionandduringthemomentthey

parateitfromthebrain;inbothcastheuofhaemostaticagentiscritical

UsingHaemoCerinpatientsbeingoperatedonwiththediagnosisofMalignant

BrainTumor:weapplytheagentduringtherectionprocedure,considering

thatinthecasthetumorisinfiltratingthebrainparenchymawithinit,and

duringtherectionusingforcepsorultrasonicaspiratorgeneratedbleeding

inthesurgicalarea,soweubipolarcoagulationforclottingbloodvesls

fromsmalltolargercaliber,butstillthereisalwayssurfacebleedinginwhich

HaemoCerplaysadecisiverole.

AthirdgroupofpatientsarethothatareoperatedforRectionof

ArteriovenousMalformationonBrainandSpinalCordinwherethebleedingis

permanentwhichischaracteristictothistypeofpathology;theuof

HaemoCeristocontributetothecascadeofhemostasisduringrectionand

alingofthesurgicalsite.

ThebenefitswehaveenarethothatenableHaemoCerforuinconjunction

withotherhemostatictoolssuchalectrobipolarcoagulation,gelatinsponge

rporateitasmandatoryequipment

fortheneurosurgeontoperformasurgerywhichprovidescurityandtrustin

theintra-operativeandpostoperativefields.

Anotheradvantageisthepropertyofthisagentasapowderallowingustotakeit

toplacesinaccessibletogelatinspongesorcellulosheets,thefactthatitisnon-

pyrogenic,thatitisabsorbedquicklyanditsmodeofactionisclearlyperceivedby

theneurosurgeoneyes

HaemoCerdemonstratescurityasitdoesnotcontainsanyhumanoranimal

componentthatcanpromoteinfection,granulomaandforeignbodyreaction,it

showfficacyforitshydrophilicnaturewhichenhancesthenaturalphysiological

coagulationcascadeviarapidplateletaggregationandcondlytheformationa

gelledmatrixwhichconstitutesamechanicalbarrierforbleeding.

DuringtheuofHaemoCerwehavenotdetectedanyadverevents.

omleyColomaMD,PhD

ChiefofNeurosurgeryDepartment

HospitalGuillermoAlmenara

LimaPeru

RAHOSPITAL

Bleedingduringatumorrectionsurgery

Uofelectrobipolarcoagulationtocontrolbleedingduringtherection

BrainpriortoHaemoCerapplication

Bleedingmustbestoppedpriortoclosing

UsingHaemoCer

ApplyingHaemoCertoachievehaemostasis.

7

Formationofthegelledmatrixasamechanicalbarrier