In neurosurgical practice, biosurgical hemostatic agents have proved to be extremely useful to complete the more classic use of electrocoagulation.
During recent years, many biosurgical topical hemostatic agents were created. Although routinely used during neurosurgical procedures, there is still a great deal of confusion concerning optimal use of these products, because of the wide range of products, as absorbable topical agents, antifibrinolytics agents, fibrin sealants and hemostatic matrix, which perform their hemostatic action in different ways. The choice of the hemostatic agent and the strategy for local hemostasis are correlated with the neurosurgical approach, the source of bleeding, and the neurosurgeon's practice.
AnkaferdBlood Stopper (herbal hemostatic)
SeraSeal (agar and bovine factor proteins)
SURGIFLO (gelatin paste)
HELITENE (absorbable collagen)
Beriplast (fibrin sealant containing fibrinogen, factor XIII, and thrombin),
TISSEEL (fibrin sealant)
BLOODCARE (hemostatic powder)
SURGICEL (oxidized cellulose polymer)
Hemostatic agents can cause notable histopathologic alterations, including inflammation, fibrosis, and vascularity. In this context, flowable hemostats such as gelatin granules and thrombin or gelatin paste seem to provide more promising results in spinal surgery 1).
Gazzeri et al., review all the different sources of bleeding during intracranial surgical approaches and analyze how to best choose the right topical hemostatic agent to stop bleeding, from the beginning of the surgical approach to the end of the extradural hemostasis after dural closure, along all the steps of the neurosurgical procedure 2).