Control of Bleeding in Endoscopic Skull Base Surgery: Current Concepts to Improve Hemostasis

Overview

Journal ISRN Surg

Specialty General Surgery

Date 2013 Jul 12

PMID 23844295

Citations 9

Authors

Cattleya Thongrong

Pornthep Kasemsiri

Ricardo L Carrau

Sergio D Bergese

Affiliations

Soon will be listed here.

Abstract

Hemostasis is critical for adequate anatomical visualization during endoscopic endonasal skull base surgery. Reduction of intraoperative bleeding should be considered during the treatment planning and continued throughout the perioperative period. Preoperative preparations include the optimization of comorbidities and cessation of drugs that may inhibit coagulation. Intraoperative considerations comprise anesthetic and surgical aspects. Controlled hypotension is the main anesthetic technique to reduce bleeding; however, there is controversy regarding its effectiveness; what the appropriate mean arterial pressure is and how to maintain it. In extradural cases, we advocate a mean arterial pressure of 65-70 mm Hg to reduce bleeding while preventing ischemic complications. For dealing intradural lesion, controlled hypotension should be cautious. We do not advocate a marked blood pressure reduction, as this often affects the perfusion of neural structures. Further reduction could lead to stroke or loss of cranial nerve function. From the surgical perspective, there are novel technologies and techniques that reduce bleeding, thus, improving the visualization of the surgical field.

Citing Articles

Premedication with intranasal versus intravenous dexmedetomidine for hypotensive anesthesia during functional endoscopic sinus surgery in adults: A randomized triple-blind trial.

Kohaf N, Harby S, Abd-Ellatief A, Elsaid M, Abdelmottaleb N, Abd Elsalam T Heliyon. 2024; 10(3):e25175.

PMID: 38322885 PMC: 10844284. DOI: 10.1016/j.heliyon.2024.e25175.

Advances in the development and optimization strategies of the hemostatic biomaterials.

Guo Y, Cheng N, Sun H, Hou J, Zhang Y, Wang D Front Bioeng Biotechnol. 2023; 10:1062676.

PMID: 36714615 PMC: 9873964. DOI: 10.3389/fbioe.2022.1062676.

Transnasal endoscopic skull base surgery in the COVID-19 era: Recommendations for increasing the safety of the method.

Lyson T, Kisluk J, Alifier M, Politynska-Lewko B, Sieskiewicz A, Kochanowicz J Adv Med Sci. 2021; 66(1):221-230.

PMID: 33744516 PMC: 7931688. DOI: 10.1016/j.advms.2021.03.001.

Evaluation of selected parameters of the coagulation system during the perioperative period in patients undergoing endoscopic surgery of the paranasal sinuses.

Urbaniak J, Owczarek K, Milonski J, Pietkiewicz P, Jalocha-Kaczka A, Olszewski J Arch Med Sci. 2020; 16(6):1336-1345.

PMID: 33224332 PMC: 7667416. DOI: 10.5114/aoms.2017.72544.

Is Pterygopalatine Fossa Injection with Adrenaline an Effective Technique for Better Surgical Field in Fess?.

Shenoy V, Prakash N, Kamath P, Rao R, Deviprasad D, Prasad V Indian J Otolaryngol Head Neck Surg. 2017; 69(4):464-473.

PMID: 29238675 PMC: 5714914. DOI: 10.1007/s12070-017-1225-z.

References

Douketis J, Berger P, Dunn A, Jaffer A, Spyropoulos A, Becker R . The perioperative management of antithrombotic therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008; 133(6 Suppl):299S-339S. DOI: 10.1378/chest.08-0675. View

White R, McKittrick T, Hutchinson R, Twitchell J . Temporary discontinuation of warfarin therapy: changes in the international normalized ratio. Ann Intern Med. 1995; 122(1):40-2. DOI: 10.7326/0003-4819-122-1-199501010-00006. View

Fraser J, Mass A, Brown S, Anand V, Schwartz T . Transnasal endoscopic resection of a cavernous sinus hemangioma: technical note and review of the literature. Skull Base. 2009; 18(5):309-15. PMC: 2637061. DOI: 10.1055/s-0028-1086059. View

Harrison P, Mackie I, Mumford A, Briggs C, Liesner R, Winter M . Guidelines for the laboratory investigation of heritable disorders of platelet function. Br J Haematol. 2011; 155(1):30-44. DOI: 10.1111/j.1365-2141.2011.08793.x. View

Elhammady M, Peterson E, Johnson J, Aziz-Sultan M . Preoperative onyx embolization of vascular head and neck tumors by direct puncture. World Neurosurg. 2011; 77(5-6):725-30. DOI: 10.1016/j.wneu.2011.02.033. View

Sieskiewicz A, Drozdowski A, Rogowski M . [The assessment of correlation between mean arterial pressure and intraoperative bleeding during endoscopic sinus surgery in patients with low heart rate]. Otolaryngol Pol. 2010; 64(4):225-8. DOI: 10.1016/S0030-6657(10)70020-2. View

Stangerup S, Thomsen H . Histological changes in the nasal mucosa after hot-water irrigation. An animal experimental study. Rhinology. 1996; 34(1):14-7. View

Douketis J, Woods K, Foster G, Crowther M . Bridging anticoagulation with low-molecular-weight heparin after interruption of warfarin therapy is associated with a residual anticoagulant effect prior to surgery. Thromb Haemost. 2005; 94(3):528-31. DOI: 10.1160/TH05-01-0064. View

Yoo H, Han J, Park S, Kim K . Comparison of surgical condition in endoscopic sinus surgery using remifentanil combined with propofol, sevoflurane, or desflurane. Korean J Anesthesiol. 2011; 59(6):377-82. PMC: 3022129. DOI: 10.4097/kjae.2010.59.6.377. View

10.

Ahn H, Chung S, Dhong H, Kim H, Ahn J, Lee S . Comparison of surgical conditions during propofol or sevoflurane anaesthesia for endoscopic sinus surgery. Br J Anaesth. 2007; 100(1):50-4. DOI: 10.1093/bja/aem304. View

11.

Gilbey P, Kukuev Y, Samet A, Talmon Y, Ivry S . The quality of the surgical field during functional endoscopic sinus surgery--the effect of the mode of ventilation--a randomized, prospective, double-blind study. Laryngoscope. 2009; 119(12):2449-53. DOI: 10.1002/lary.20614. View

12.

Peterson P, Hayes T, Arkin C, Bovill E, Fairweather R, Rock Jr W . The preoperative bleeding time test lacks clinical benefit: College of American Pathologists' and American Society of Clinical Pathologists' position article. Arch Surg. 1998; 133(2):134-9. DOI: 10.1001/archsurg.133.2.134. View

13.

Stangerup S, Dommerby H, Siim C, Kemp L, Stage J . New modification of hot-water irrigation in the treatment of posterior epistaxis. Arch Otolaryngol Head Neck Surg. 1999; 125(6):686-90. DOI: 10.1001/archotol.125.6.686. View

14.

HUGOSSON R, HOGSTROM S . Factors disposing to morbidity in surgery of intracranial aneurysms with special regard to deep controlled hypotension. J Neurosurg. 1973; 38(5):561-7. DOI: 10.3171/jns.1973.38.5.0561. View

15.

Kovacs M, Kearon C, Rodger M, Anderson D, Turpie A, Bates S . Single-arm study of bridging therapy with low-molecular-weight heparin for patients at risk of arterial embolism who require temporary interruption of warfarin. Circulation. 2004; 110(12):1658-63. DOI: 10.1161/01.CIR.0000142859.77578.C9. View

16.

Mengistu A, Wolf M, Boldt J, Rohm K, Suttner S, Piper S . Influence of controlled hypotension using esmolol and sodium nitroprusside on natriuretic peptides in patients undergoing endonasal sinus surgery. Eur J Anaesthesiol. 2007; 24(6):529-34. DOI: 10.1017/S0265021506002286. View

17.

Cohen-Kerem R, Brown S, Villasenor L, Witterick I . Epinephrine/Lidocaine injection vs. saline during endoscopic sinus surgery. Laryngoscope. 2008; 118(7):1275-81. DOI: 10.1097/MLG.0b013e31816dd2d9. View

18.

Gall R, Witterick I, Shargill N, Hawke M . Control of bleeding in endoscopic sinus surgery: use of a novel gelatin-based hemostatic agent. J Otolaryngol. 2003; 31(5):271-4. DOI: 10.2310/7070.2002.29810. View

19.

Sekhar L, Natarajan S, Manning T, Bhagawati D . The use of fibrin glue to stop venous bleeding in the epidural space, vertebral venous plexus, and anterior cavernous sinus: technical note. Neurosurgery. 2007; 61(3 Suppl):E51. DOI: 10.1227/01.neu.0000289711.95426.50. View

20.

Woodworth B, Chandra R, LeBenger J, Ilie B, Schlosser R . A gelatin-thrombin matrix for hemostasis after endoscopic sinus surgery. Am J Otolaryngol. 2008; 30(1):49-53. DOI: 10.1016/j.amjoto.2007.11.008. View