Abstract
Objective Recurrent brain tumors represent a challenge for neurosurgeons because of the extensive
blood loss and the time needed for surgical resection. Only a few hemostatic agents
are useful to prevent the bleeding and thus facilitate the surgical resection. Fibrin
sealant can be used to achieve sealing, tissue adherence, or hemostasis when other
means of hemostasis are inadequate or inappropriate. We report the feasibility and
positive effects of direct intratumoral injection of fibrin sealant during resection
of a recurrent hemangiopericytoma.
Material and Methods The intraoperative intratumoral injection of fibrin sealant changed the tumor properties
of a recurrent hemangiopericytoma of the tentorium with infra- and supratentorial
extension. From a loose friable briskly bleeding tumor, this complex lesion became
a nonbleeding well-demarcated soft-firm tumor that could easily be dissected off the
pial surface and totally resected without extensive bleeding.
Results There are several benefits of intratumoral injection of fibrin sealant in hemangiopericytomas:
(1) the extensive bleeding is diminished and blood loss minimized; (2) the restriction
of the surgical view by the venous oozing is diminished, making the microsurgical
dissection of the tumor capsule off the pial surface easier and safer; (3) the loose
consistency of the tumor becomes firmer and facilitates the manipulation of the tumor
and leads to a safer resection; and (4) a shorter operating time is needed.
Conclusion The use of intratumoral fibrin glue injection is a safe and useful technique that
could be used for hemostasis of highly vascularized tumors to facilitate a safer resection
and to reduce blood loss.
Keywords
hemangiopericytoma - fibrin sealant - safety - intraoperative surgical technique -
embolization
