Published in:
Open Access
01-12-2019 | Meningioma | Case Report
Case Report of a Novel Technique for Repair
of the Vertebral Artery During Cranial Surgery
Authors:
Manjunath Prasad, Nitin Mukerji
Published in:
Neurology and Therapy
|
Issue 2/2019
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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the cerebellum was retracted with cerebrospinal fluid being released.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 anN-hydroxysuccinimide-functionalized
polyethylene glycol-coated collagen patch (Hemopatch®,
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.
Funding: There was no funding for
this case report. Baxter Healthcare Ltd. provided funding for preparation of this
manuscript and the journal’s Rapid Service Fee.