Application of a thrombin-gelatin matrix in the management of intractable hemorrhage during stereotactic biopsy: a Technical Note.

BACKGROUND: Few studies have been published about percutaneous techniques for the 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.

METHODS: We prospectively documented image-guided stereotactic brain biopsy procedures on 30 awake patients between July 2014 and July 2017 at our center. Among those patients presenting with intractable surgical bed bleeding, a thrombin-gelatin matrix injection was used through the biopsy cannula. Details of the injection technique, surgical outcome and complications were recorded.

RESULTS: We documented 30 stereotactic brain biopsies. 3 (10%) of these cases had intractable surgical bed bleeding during the procedure. In all 3 cases, thrombin-gelatin matrix was injected and an immediate arrest was achieved. Neither of the patients required a craniotomy or further invasive measure to achieve the hemostasis. No postoperative complications were recorded.

CONCLUSION: Our preliminary results suggest that the 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.