• Cristian de Quintana-Schmidt, Andreas Leidinger, Joan Molet Teixidó, and Gerardo Conesa Bertrán.
• Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Electronic address: cquintana@santpau.cat.
• World Neurosurg. 2019 Jan 1; 121: 180-185.

BackgroundFew studies have been published about percutaneous techniques for management of surgical bed hemorrhage during a stereotactic biopsy, a serious complication that may affect patient outcome. We describe the injection of a thrombin-gelatin matrix through the biopsy cannula as an effective method to arrest surgical bed bleeding that does not respond to conventional methods of hemostasis.MethodsWe prospectively documented image-guided stereotactic brain biopsy procedures in 30 awake patients between July 2014 and July 2017 at our center. Among patients presenting with intractable surgical bed bleeding, a thrombin-gelatin matrix injection through the biopsy cannula was performed. Details of the injection technique, surgical outcome, and complications were recorded.ResultsAmong 30 documented stereotactic brain biopsies, 3 (10%) had intractable surgical bed bleeding during the procedure. In all 3 cases, thrombin-gelatin matrix was injected, and an immediate arrest of hemorrhage was achieved. None of the patients required a craniotomy or further invasive measure to achieve hemostasis. No postoperative complications were recorded.ConclusionsOur preliminary results suggest that thrombin-gelatin matrix injection is a simple, safe, and effective stereotactic practice to manage persistent surgical bed bleeding that cannot be arrested by standard, conventional hemostatic methods.Copyright © 2018 Elsevier Inc. All rights reserved.

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