Use of Tissue-Glue–Coated Collagen Sponge (TachoSil) to Repair Minor Cerebral Dural Venous Sinus Lacerations

Abstract

Abstract BACKGROUND Significant hemorrhage may occur from the cerebral venous sinuses during the dural separation from the bone flap, particularly in elderly patients. It is important to achieve an urgent hemostatic control. OBJECTIVE To evaluate the efficacy and safety of a new fixed combination tissue sealant (TachoSil) in patients with bleeding from lacerations of cerebral venous sinuses. METHODS Between September 2012 and June 2014, 57 patients (39 female, 18 male) presenting with iatrogenic tears of the superior sagittal or transverse/sigmoid sinuses were treated with a topical fibrin sealant patch. Intraoperative source of bleeding, time to bleeding control, quantity of sealant sponge used, and postoperative complications were evaluated. Time to hemostasis was used as the primary end point. RESULTS Effective hemostasis, defined as cessation of bleeding after application of topical hemostatic agent, was achieved no later than 4 minutes in all except 5 patients with persistent bleeding from the sinus. In these 5 cases, bleeding was finally stopped after application of a new larger layer of TachoSil Sponge (2 cases) or gelatin hemostatic matrix (2 cases) or fibrin glue (1 case) over the layer of TachoSil. CONCLUSION We report our experience with a new hemostasis technique to manage bleeding from iatrogenic lacerations of cerebral venous sinuses.