Use of Hemostatic Matrix for Hemostasis of the Cavernous Sinus during Endoscopic Endonasal Pituitary and Suprasellar Tumor Surgery

ABSTRACT

The endoscopic endonasal approach offers a wide, panoramic exposure of the sellar floor, planum, and clivus. The ability to expose fully the tumor margins, through lateral extension of cavernous sinuses, increases the exposure and ability to resect the tumor but increases the risk of bleeding. The authors describe achieving hemostasis using a hemostatic matrix, FloSeal (Baxter Biosciences, Vienna, Austria) sealant, during endoscopic endonasal tumor removal, specifically for pituitary and suprasellar tumors. Thirty-nine cases (33 pituitary adenomas, 4 craniopharyngiomas, 1 clival plasmacytoma, and 1 planum meningioma) are described using this technique. FloSeal was injected directly to the site of bleeding, and a cottonoid was used for further tamponade, immediately achieving hemostasis with no hemorrhagic complications in any of the patients. Surgery could be immediately pursued without any delay. This simple nuance can be used as a safe method in cavernous sinus hemostasis during endoscopic endonasal surgery and may decrease operative time.

KEYWORDS

Cavernous sinus - FloSeal - endoscopic endonasal - hemostasis

REFERENCES

• 1 de Divitiis E, Cavallo L M, Cappabianca P, Esposito F. Extended endoscopic endonasal transsphenoidal approach for the removal of suprasellar tumors: Part 2.  Neurosurgery. 2007;  60 46-58 discussion 58-59
• 2 Dehdashti A R, Ganna A, Witterick I, Gentili F. Expanded endoscopic endonasal approach for anterior cranial base and suprasellar lesions: indications and limitations.  Neurosurgery. 2009;  64 677-687 discussion 687-689
• 3 Dehdashti A R, Ganna A, Karabatsou K, Gentili F. Pure endoscopic endonasal approach for pituitary adenomas: early surgical results in 200 patients and comparison with previous microsurgical series.  Neurosurgery. 2008;  62 1006-1015 discussion 1015-1017
• 4 FloSeal [Hemostatic Matrix] Instructions for Use. Available at: http://www.baxter.com/products/biopharmaceuticals/downloads/FloSeal_PI.pdf Accessed May 24, 2010
• 5 Payner T D, Vega F, Taw J et al.. FloSeal Matrix Hemostatic Sealant. Safety, Biocompatibility, and Biodegradation-Brain Implantation Study in Rats. Baxter Technical Bulletin 2002; Rev. No. 01–050. 
• 6 Phookan G, Davis A T, Holmes B. Hemangioendothelioma of the cavernous sinus: case report.  Neurosurgery. 1998;  42 1153-1155 discussion 1155-1156
• 7 Kim E H, Ahn J Y, Chang J H, Kim S H. Management strategies of intercavernous sinus bleeding during transsphenoidal surgery.  Acta Neurochir (Wien). 2009;  151 803-808
• 8 Fraser J F, Mass A Y, Brown S, Anand V K, Schwartz T H. Transnasal endoscopic resection of a cavernous sinus hemangioma: technical note and review of the literature.  Skull Base. 2008;  18 309-315
• 9 Sekhar L N, Natarajan S K, Manning T, Bhagawati D. The use of fibrin glue to stop venous bleeding in the epidural space, vertebral venous plexus, and anterior cavernous sinus: technical note.  Neurosurgery. 2007;  61 (3 Suppl) E51 discussion E51