Background: Hemostasis plays an important role in safe brain tumor resection and also reduces the risk for surgical complications. This study aimed to evaluate the efficacy of FLOSEAL®, a topical hemostatic agent that contains thrombin and gelatin granules, in brain tumor resections. Methods: We evaluated the hemostatic effect of FLOSEAL by scoring the intensity of bleeding from 1 (mild) to 4 (life threatening). We assessed the rate of success of hemostasis with 100 patients who underwent intracranial tumor resection. We also investigated the duration of the operation, the amount of intra- and postoperative bleeding, the number of hospital stays, and adverse events in patients who used FLOSEAL compared with those who did not use FLOSEAL. Results: FLOSEAL was applied to a total of 109 bleeding areas in 100 patients. A total of 95 bleeding areas had a score of 1 and 91 (96%) showed successful hemostasis. Thirteen bleeding areas scored 2 and 8 (62%) showed hemostasis with the first application of FLOSEAL. The second application was attempted with five bleeding areas and four showed hemostasis. About 94% (103/109 areas) of bleeding points successfully achieved hemostasis by FLOSEAL. Moreover, FLOSEAL significantly decreased the amount of intraoperative bleeding and postoperative bleeding as assessed with computed tomography on 1 day postoperatively compared with no use of FLOSEAL. There were no adverse events related to FLOSEAL use. Conclusion: Our results indicate that FLOSEAL is a reliable, convenient, and safe topical hemostatic agent for intracranial tumor resection.

Global warming increases heatstroke incidence. After heatstroke, patients exhibit neurological symptoms, suggesting cerebellar damage. However, the potential long-term adverse outcomes are poorly understood. We studied the cerebellum after heatstroke in mouse heatstroke models. In this study, motor coordination disorder significantly appeared 3 weeks after heatstroke and gradually improved to some extent. Although white matter demyelination was detected at 1 and 3 weeks after heatstroke in the cerebellum, it was not found in the corpus callosum. The Purkinje cell numbers significantly decreased at 1, 3, and 9 weeks after heatstroke. The intensity of synaptophysin and postsynaptic density-95 temporarily appeared to attenuate at 3 weeks after heatstroke; however, both appeared to intensify at 9 weeks after heatstroke. Motor coordination loss occurred a few weeks after heatstroke and recovered to some extent. Late-onset motor impairment was suggested to be caused by cerebellar dysfunctions morphologically assessed by myelin staining of cerebellar white matter and immunostaining of Purkinje cells with pre- and postsynaptic markers. Purkinje cell number did not recover for 9 weeks; other factors, including motor coordination, partially recovered, probably by synaptic reconstruction, residual Purkinje cells, and other cerebellar white matter remyelination. These phenomena were associated with late-onset neurological deficits and recovery after heatstroke.

We experienced an extremely rare case of a giant P1-P2 partially thrombosed aneurysm associated with bilateral ICA occlusion in a Klippel-Trenaunay syndrome patient. In our experience, direct surgical clipping via a pterional approach is generally favored for aneurysms located in the junction of the P1-P2 segments, even if they are giant.

A great challenge hindering the use of cellulose nanofibers (CNF) as a reinforcing filler in bio-based polymeric matrices are their poor chemical compatibility. This is because of the inherent hydrophilic nature of CNF and the hydrophobic nature of the polymeric matrix. In this study, cellulose laminates were prepared by using CNF as a filler and cellulose acetate butyrate (CAB) as the polymer matrix. To improve the compatibility between CAB and CNF, the residual hydroxyl groups of CAB and the hydroxyl groups on the surface of CNF were cross-linked with bio-derived polyisocyanurate D376N (STABiO™). The composite material was obtained in one step by sandwiching a CNF sheet (10 wt%) coated with a cross-linking agent between CAB films (90 wt%) using hot pressing. When 14.3 wt% of the cross-linking agent to the total weight of CNF and CAB was added, the tensile strength and flexural strength were improved by 72.4% and 16.3%, respectively, compared with neat CAB. It was concluded that this increase in strength is a result of both: cross-linking between the CNF sheets as well as the cross-linking occurring at the CNF/CAB interface.

Pseudoaneurysms of the internal carotid artery (ICA) and sphenopalatine artery (SPA) are recognized as sources of arterial epistaxis following head and face trauma. However, epistaxis involving pseudoaneurysm of the anterior ethmoidal artery (AEA) is extremely rare. Case Presentation: A 25-year-old man experienced massive epistaxis due to a ruptured traumatic pseudoaneurysm of the AEA. The patient had suffered head and face trauma in a car accident. CT showed fractures of the frontal, ethmoidal, and maxillary bones, and he was managed conservatively. Nine days after the injury, he had sudden, massive epistaxis. Angiography showed a right AEA aneurysm, which was treated successfully with transarterial embolization using n-butyl-2-cyanoacrylate (NBCA). Conclusion: Although pseudoaneurysm of the AEA is a rare cause of epistaxis, it is important to consider this diagnosis, in addition to pseudoaneurysm of the SPA and ICA, when a patient has massive arterial epistaxis following a traumatic skull base fracture, especially if the fracture is adjacent to the ethmoid sinus. Transarterial embolization using glue is a feasible therapeutic option for this condition.