• Paolo Cappabianca, Felice Esposito, Isabella Esposito, Luigi Maria Cavallo, and Carlo Antonio Leone.
• Department of Neurological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Via Pansini 5, Naples, Italy. paolo.cappabianca@unina.it
• Acta Neurochir (Wien). 2009 Jan 1;151(1):69-77; discussion 77.

ObjectiveThe management of intradural bleeding during extended endoscopic endonasal surgery is challenging. This technical note describes the use of a biological haemostatic agent which could be useful when other established strategies and materials are not effective.Materials And MethodsFrom January 2004 to January 2008, 65 consecutive patients underwent extended endoscopic endonasal interventions. Of these, 29 procedures required the application of a thrombin-gelatin haemostatic matrix. We reviewed the patients' operative records to determine the source, type of bleeding and haemostatic strategy.ResultsWe analysed bleedings from the venous sinuses, arteries, tumour bed and internal carotid artery and observed complete haemostasis immediately after application of FloSeal. The matrix was useful for both oozing and focal haemorrhage and effective even for high-flow bleeding. Only bleeding from an internal carotid artery tear required a second application.ConclusionThe thrombin-gelatin matrix could represent a valuable tool when other haemostatic strategies are ineffective or suboptimal. It is safe and biocompatible when compared with haemostatic agents currently in use.

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