Arterial Bleeding
- Bipolar coagulation is traditionally thought to be the sole mode of hemostasis for arterial bleeding during microsurgery.
- Depending on the importance of the artery and its caliber, primary closure of the tear is ideal, if possible.
Bleeding from a Dural Venous Sinus
- The size of the tear in the venous sinus wall determines the course of action to secure hemostasis and preserve the venous lumen.
- Large tears are ideally managed through primary closure using fine sutures.
- However, this is usually not feasible and the closure must be reinforced with a piece of pericranium or muscle.
- Alternatively, the dura can be reflected over the tear and used to reconstruct the roof of the venous sinus.
- Please refer to the chapter on Repair of the Dural Venous Sinus Injury for more details.
- Excessive bleeding from the cavernous sinus can be controlled using injections of fibrin glue.
Diffuse Venous Bleeding
- Severe closed head injury or excessive bleeding and massive blood replacement can lead to uncontrollable diffuse venous bleeding due to alterations in hemostatic mechanisms.
- This emergency requires an assessment of the patient’s global hemostatic parameters.
- Thrombin-soaked Gelfoam powder can be effective transiently.
- Correction of the underlying cause of disseminated intravascular coagulation (DIC) is the best strategy.
- When diffuse venous bleeding occurs, it is often best to abort the procedure immediately and return a week or two later for the second stage of the operation.
Bone Bleeding
- Bone wax is the most reasonable solution for bone bleeding.
- Floseal powder (Baxter, Deerfield, IL) is also effective for bone and venous bleeding especially during endonasal endoscopic surgery.
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