The implication of liquid hemostatic matrices to prevent hemorrhages during stereotactic biopsy of brain tumors

Purpose of the study. Development of a method for preventing hemorrhages during stereotactic biopsy of a brain tumor using liquid hemostatic matrices on the example of the drug "Floseal^®".

Patients and methods. The target of the biopsy is the most representative area of tumor tissue according to the data of various modalities of MRI neuroimaging, including contrast-enhanced ones. Out of 133 patients, 60 patients with signs of intraoperative bleeding along the biopsy needle cannula were included in the study group. Further, patients with signs of intraoperative bleeding along the cannula of the biopsy needle were divided into 2 subgroups by independent sequential randomization. Control subgroup (n = 45): cases with signs of intraoperative bleeding of varying severity were operated on, according to the standard technique, without the use of the liquid hemostatic drug Floseal^®. The main subgroup (n = 15): in case of intraoperative signs of bleeding, the hemostatic fluid drug Floseal^® was injected into the area of tumor material removal.

Results. In 6.7 % of patients of the control subgroup, the formation of massive intracerebral hemorrhages was noted in the postoperative period. In 53.3 % of the observations of the control subgroup according to X-ray computer examinations of the brain, there were signs of minor hemorrhages at the point of tumor material collection, which did not require repeated surgical interventions. Postoperative hemorrhages after injection of the Floseal^® liquid hemostatic matrix into the biopsy needle in the study subgroup were not detected according to neuroimaging X-ray CT.

Conclusion. A method of hemostasis has been developed to prevent hemorrhages using liquid hemostatic matrices. If signs of bleeding from the biopsy needle appeare, the introduction of a hemostatic matrix in the volume of 2 ml helps to manage bleeding intraoperatively, as well as to prevent the occurrence of hemorrhage in the early postoperative period.

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