Background: Since the beginning of neurosurgery, intraoperative parenchymal bleeding has been
a major problem. Achievement of hemostasis is the endpoint of any cranial or spinal
neurosurgical exercise and is mandatory to avoid postoperative hematomas which mar
the ultimate outcome of the surgery. Several biosurgical agents are used to achieve
this goal. Agents such as oxidized cellulose, gelatin foam, fibrillar collagen, fibrin
sealants, and antifibrinolytic agents are used, each having a different mechanism
of action. Materials and Methods: The authors describe a simple technique for substituting oxidized regenerated cellulose
(Surgicel) for lining the surgical cavities after excising brain lesions, with customized
gelfoam wafers fashioned on the surgical trolley. This has been used in over 8000
cases with excellent hemostatic results over the last 25 years. No complications are
noted with use of these wafers. Results: In a randomized trial done by us, similar hemostatic effect was found between oxycel
and the gelfoam wafers described by us with satisfactory outcomes of surgeries. No
previous use of such custom-fashioned wafers has been described for neurosurgical
hemostasis in the literature.
Key-words:
Bespoke - gelfoam - hemostasis - oxidized cellulose
