Local hemostatic matrix for endoscope-assisted removal of intracerebral hemorrhage is safe and effective

Hui Tzung Luh, Abel Po Hao Huang, Shih Hung Yang, Chien Ming Chen, Der Yang Cho, Chun Chung Chen, Lu Ting Kuo, Chieh Hsun Li, Kuo Chuan Wang, Wei Lung Tseng, Ming Tai Hsing, Bing-Shiang Yang, Dar Ming Lai, Jui Chang Tsai*

*Corresponding author for this work

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

Background/Purpose: Minimally invasive endoscope-assisted (MIE) evacuation of spontaneous intracerebral hemorrhage (ICH) is simple and effective, but the limited working space may hinder meticulous hemostasis and might lead to rebleeding. Management of intraoperative hemorrhage is therefore a critical issue of this study. This study presents experience in the treatment of patients with various types of ICH by MIE evacuation followed by direct local injection of FloSeal Hemostatic Matrix (Baxter Healthcare Corp, Fremont, CA, USA) for hemostasis. Methods: The retrospective nonrandomized clinical and radiology-based analysis enrolled 42 patients treated with MIE evacuation of ICH followed by direct local injection of FloSeal Hemostatic Matrix. Rebleeding, morbidity, and mortality were the primary endpoints. The percentage of hematoma evacuated was calculated from the pre- and postoperative brain computed tomography (CT) scans. Extended Glasgow Outcome Scale (GOSE) was evaluated at 6 months postoperatively. Results: Forty-two ICH patients were included in this study, among these, 23 patients were putaminal hemorrhage, 16 were thalamic ICH, and the other three were subcortical type. Surgery-related mortality was 2.4%. The average percentage of hematoma evacuated was 80.8%, and the rebleeding rate was 4.8%. The mean operative time was 102.7 minutes and the average blood loss was 84.9 mL. The mean postoperative GOSE score was 4.55 at 6-months' follow-up. Conclusion: This study shows that local application of FloSeal Hemostatic Matrix is safe and effective for hemostasis during MIE evacuation of ICH. In our experience, this shortens the operation time, especially in cases with intraoperative bleeding. A large, prospective, randomized trial is needed to confirm the findings.

Original languageEnglish
Pages (from-to)63-70
Number of pages8
JournalJournal of the Formosan Medical Association
Volume117
Issue number1
DOIs
StatePublished - 1 Jan 2018

Keywords

  • Endoscope-assisted surgery
  • FloSeal Hemostatic Matrix
  • Local hemostatic agent
  • Minimally invasive surgery
  • Spontaneous intracerebral hemorrhage

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    Luh, H. T., Huang, A. P. H., Yang, S. H., Chen, C. M., Cho, D. Y., Chen, C. C., Kuo, L. T., Li, C. H., Wang, K. C., Tseng, W. L., Hsing, M. T., Yang, B-S., Lai, D. M., & Tsai, J. C. (2018). Local hemostatic matrix for endoscope-assisted removal of intracerebral hemorrhage is safe and effective. Journal of the Formosan Medical Association, 117(1), 63-70. https://doi.org/10.1016/j.jfma.2017.02.016