Case Report of a Novel Technique for Repair of the Vertebral Artery During Cranial Surgery

Abstract

Surgery of complex cranial base lesions carries a high risk of damage to main vessels, often resulting in life-changing or even life-threatening injuries. We describe a rapid, effective, and noninvasive application of a collagen-based hemostatic patch to repair the vertebral artery during cranial surgery. A 61-year-old male patient underwent retrosigmoid craniotomy to remove a foramen magnum meningioma that encased the vertebral artery. A linear incision was made behind the ear and standard retrosigmoid craniotomy was performed with preservation of the transverse and sigmoid sinuses. The dura was opened in a Y-shaped fashion and the cerebellum was retracted with cerebrospinal fluid being released. Removing the exposed tumor from the artery resulted in a small arterial bleed. Two pieces of an N-hydroxysuccinimide-functionalized polyethylene glycol-coated collagen patch (Hemopatch Ò , Baxter Healthcare Ltd.) were applied sequentially and were pressed to the bleed site for 2 min each. Hemostasis of the vertebral artery was achieved at the patient's regular blood pressure. There was no postoperative bleeding, dissection or pseudoaneurysm. The patient recovered gradually with several cranial nerve deficits. There was no brain stem stroke. Twelve months on, the patient has made an excellent recovery from surgery, is independently mobile and has minimal cranial nerve deficits. Application of the collagen-based hemostatic patch proved to be an efficient, safe, and noninvasive technique that achieved rapid hemostasis, confirming its effectiveness in complicated surgery, where risk of hemorrhage can be critical for the surgery outcome.

The role of hemostatic devices in neurosurgery. A systematic review

“…Inc., Deerfield, IL, USA) is a polyethylene glycol-covered matrix of collagen derived from the bovine dermis. It has been proven as an effective sealant in animal models and clinical practice [63,64]. It may be safely used as a dural sealant and hemostatic for low-flow and diffuse bleeding in cranial and spinal neurosurgical procedures [64].…”

Hemopatch® is effective and safe to use: real-world data from a prospective European registry study

“…Several case series and smaller studies describe the effective and reliable use of Hemopatch ® in a variety of clinical applications, including solid organ, neurological, gastrointestinal, biliopancreatic, endocrine, urologic and cardiovascular procedures [6][7][8][9][10][11][12][13][14][15][16][17][18].…”