Efficacy of a topical gelatin-thrombin hemostatic matrix, FLOSEAL®, in intracranial tumor resection

Dai Kamamoto; Tokunori Kanazawa; Eriko Ishihara; Kaoru Yanagisawa; Hideyuki Tomita; Ryo Ueda; Masahiro Jinzaki; Kazunari Yoshida; Masahiro Toda

doi:10.25259/SNI_272_2019

Efficacy of a topical gelatin-thrombin hemostatic matrix, FLOSEAL^®, in intracranial tumor resection

Surg Neurol Int. 2020 Feb 7:11:16. doi: 10.25259/SNI_272_2019. eCollection 2020.

Authors

Dai Kamamoto¹, Tokunori Kanazawa¹, Eriko Ishihara¹, Kaoru Yanagisawa¹, Hideyuki Tomita², Ryo Ueda³, Masahiro Jinzaki⁴, Kazunari Yoshida¹, Masahiro Toda¹

Affiliations

¹ Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo.
² Department of Neurosurgery, Japanese Red Cross Ashikaga Hospital, 284-1 Yobe-cho, Ashikaga city, Tochigi.
³ Department of Neurosurgery, Kawasaki Municipal Hospital, 12-1 Shinkawadori, Kawasaki-ku, Kawasaki city, Kanagawa.
⁴ Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.

Abstract

Background: Hemostasis plays an important role in safe brain tumor resection and also reduces the risk for surgical complications. This study aimed to evaluate the efficacy of FLOSEAL^®, a topical hemostatic agent that contains thrombin and gelatin granules, in brain tumor resections.

Methods: We evaluated the hemostatic effect of FLOSEAL by scoring the intensity of bleeding from 1 (mild) to 4 (life threatening). We assessed the rate of success of hemostasis with 100 patients who underwent intracranial tumor resection. We also investigated the duration of the operation, the amount of intra- and postoperative bleeding, the number of hospital stays, and adverse events in patients who used FLOSEAL compared with those who did not use FLOSEAL.

Results: FLOSEAL was applied to a total of 109 bleeding areas in 100 patients. A total of 95 bleeding areas had a score of 1 and 91 (96%) showed successful hemostasis. Thirteen bleeding areas scored 2 and 8 (62%) showed hemostasis with the first application of FLOSEAL. The second application was attempted with five bleeding areas and four showed hemostasis. About 94% (103/109 areas) of bleeding points successfully achieved hemostasis by FLOSEAL. Moreover, FLOSEAL significantly decreased the amount of intraoperative bleeding and postoperative bleeding as assessed with computed tomography on 1 day postoperatively compared with no use of FLOSEAL. There were no adverse events related to FLOSEAL use.

Conclusion: Our results indicate that FLOSEAL is a reliable, convenient, and safe topical hemostatic agent for intracranial tumor resection.

Keywords: Brain tumor; FLOSEAL®; Intraoperative hemorrhage; Postoperative hematoma; Topical gelatin- thrombin hemostatic matrix.