Aulogous fibrin sealant (Vivostat®) in the neurosurgical practice: Part II: Vertebro-spinal procedures

Background: Epidural hematomas, cerebrospinal fluid fistula, and spinal infections are challenging postoperative complications following vertebro-spinal procedures. We report our preliminary results using autologous fibrin sealant as both fibrin glue and a hemostatic during these operations. Methods: Prospectively, between January 2013 and March 2015, 68 patients received an autologous fibrin sealant prepared with the Vivostat®system applied epidurally to provide hemostasis and to seal the dura. The surgical technique, time to bleeding control, and associated complications were recorded. Results: Spinal procedures were performed in 68 patients utilizing autologous fibrin glue/Vivostat®to provide rapid hemostasis and/or to seal the dura. Only 2 patients developed postoperative dural fistulas while none exhibited hemorrhages, allergic reactions, systemic complications, or infections. Conclusions: In this preliminary study, the application of autologous fibrin sealant with Vivostat®resulted in rapid hemostasis and/or acted as an effective dural sealant. Although this product appears to be safe and effective, further investigations are warranted

Autologous fibrin sealant (Vivostat®) in the neurosurgical practice: Part I: Intracranial surgical procedure

Background: Hemorrhages, cerebrospinal fluid (CSF) fistula and infections are the most challenging postoperative complications in Neurosurgery. In this study, we report our preliminary results using a fully autologous fibrin sealant agent, the Vivostat® system, in achieving hemostasis and CSF leakage repair during cranio-cerebral procedures. Methods: From January 2012 to March 2014, 77 patients were studied prospectively and data were collected and analyzed. Autologous fibrin sealant, taken from patient's blood, was prepared with the Vivostat® system and applied on the resection bed or above the dura mater to achieve hemostasis and dural sealing. The surgical technique, time to bleeding control and associated complications were recorded. Results: A total of 79 neurosurgical procedures have been performed on 77 patients. In the majority of cases (98%) the same autologous fbrin glue provided rapid hemostasis and dural sealing. No patient developed allergic reactions or systemic complications in association with its application. There were no cases of cerebral hematoma, swelling, infection, or epileptic seizures after surgery whether in the immediate or in late period follow-up. Conclusions: In this preliminary study, the easy and direct application of autologous fibrin sealant agent helped in controlling cerebral bleeding and in providing prompt and efficient dural sealing with resolution of CSF leaks. Although the use of autologous fibrin glue seems to be safe, easy, and effective, further investigations are strongly recommended to quantify real advantages and potential limitations

The Transcallosal Anterior Interfoniceal Approach: A microsurgical anatomy study

Objectives: A plethora of surgical strategies have been described to reach deeply lesions situated within the third ventricle, including the Rosenfeld or anterior transcallosal interfoniceal approach (TAIF). Firstly, introduced in 2001, it consists of a small callosotomy followed by the midline transseptal dissection of fornices to enter the roof of the third ventricle. The aim of this microsurgical anatomy study is to describe and show each stage of the surgical procedure, focusing on the possible trajectories to anatomic landmarks. Participants: A total of twenty adult cadaveric specimens were used in this study. Using x3 to x40 magnifications the surgical dissection was carried out in a stepwise fashion and the transcallosal anterior interforniceal approach was performed, analyzed and described. Results: In five specimens out of ten a cavum septum pellucidum was depicted. In five cases out of twenty after the callosotomy the lateral ventricular cavities were reached. Different orientation of the microscope allowed the defining of three surgical trajectories to visualize the region of interest without exposing important functional areas. Conclusion: The TAIF represents a minimally invasive approach to the third ventricle; its tricky surgical steps make appropriate anatomical dissection training, essential to become confident and skilled in performing this approach