Control of intraoperative bleeding with hydrostatic pressure during endoscopic surgery

Abstract

Though intracranial endoscopic surgery has several advantages, poor visibility caused by bleeding from the operative field is one of its limitations. In two cases involving endoscopic III ventriculostomy the authors encountered moderate bleeding, and this was controlled with 'water column tamponade.' Following the application of hydrostatic pressure of 40-50 cmH2O for less than 2 min, the bleeding temporarily stopped and the operative field became clear. Several applications of this tamponade made it possible to complete the procedures. Although the pressure applied by the water column was not high enough to disturb the cerebrovascular autoregulation, blood pressure rose significantly during application of the water column tamponade. This method was valuable for the completion of procedures when bleeding was not at high pressure from large arteries. Careful monitoring of the blood pressure is mandatory, and adjustment of the pressure applied will make the procedure safer.

Prevention of Complications in Endoscopic Third Ventriculostomy

“…Small cortical, parenchymal or ependymal vessels may be torn. The majority of bleeding can be controlled using continuous irrigation with wash-out and generous compression28). Major bleeding is reported in 0.49% of cases due to injury to branches of the basilar artery or septal and thalamostriate veins19).…”

“…The ‘washing’ component of irrigation does not stop bleeding but the ‘compression’ exerted by the pressure from the fluid column of irrigation saline is helpful for the control of bleeding in endoscopy. Applying a water column with closure of the drainage port is a more effective way to manage the bleeding28). However, water column tamponade at high pressure for longer than 4–5 minutes may cause ischemic damage, especially when the patient is very young.…”

<title>Surgically appropriate maximum intensity projections: quantization of vessel depiction and incorporation into surgical navigation</title>

“…During neurosurgical procedures, knowledge of the location and structure of the vasculature is crucial to avoid complications and to correct vascular pathologies. Vascular injury is one of the most perilous complications due to the high-pressure nature of the brain [15][16][17][18][19] . The resulting bleeding could lead to limited visibility at the operation site and eventually, exsanguination.…”

Surgical Pearl: Instrument tamponade for punch biopsy of the scalp

“…Surgical tamponade is a concept that is routinely applied in several other subspecialties. 3,4 Although recent articles in the dermatology literature have addressed ways to maximize the efficiency of the scalp biopsy, to our knowledge the application of the tamponade method in this setting has not been described. 5 We have, therefore, devised a simple, inexpensive, and rapid technique for performing punch biopsies on the scalp.…”

“…The advantage of this procedure in transplantation of melanocytes bearing epidermis is the ability of both donor and recipient sites to heal without the slightest scarring. 3 Over the years, various types of suction apparatus have been used including the angiosterrometer, 1 the conventional respiratory or gastrointestinal suction pump, 2 the oil rotatory pump, 4 and the manually operated suction unit. 5 The initial suction blister device consisted of a motor-driven suction pump with cups, vacuum bottle, and a mercury manometer, which was expensive, heavy, and cumbersome.…”