Fibrin Glue Injection for Cavernous Sinus Hemostasis Associated with Cranial Nerve Deficit: A Case Report

Abstract Objective: Improved understanding of the microsurgical anatomy of the cranial base region has made surgery in and through the cavernous sinus safer. However, continuous venous oozing that occurs during cavernous sinus surgery can cause significant blood loss and poor visualization. We describe a technique that will help minimize cavernous sinus bleeding and improve the safety of the surgical steps. Methods: The lateral wall of the cavernous sinus is exposed. Cavernous sinus access windows between the V1 and V2 branches of the trigeminal nerve and posterior to the clinoidal internal carotid artery are used to inject fibrin glue into the different cavernous sinus compartments. Postoperative follow-up cerebral angiography in basilar apex aneurysms clipped using the transcavernous approach were evaluated for cavernous sinus patency during the venous phase. Results: Fibrin glue injection between V1 and V2 obliterated the lateral cavernous sinus compartment. Fibrin glue injection posterior to the clinoidal segment of the internal carotid artery obliterated the medial compartment of the cavernous sinus. These steps were used in 217 surgical procedures (95 benign and 9 malignant neoplastic lesions; 113 aneurysms). There were no significant clinical side effects. Follow-up angiographic controls of basilar aneurysms operated on via the transcavernous approach consistently showed the reestablishment of flow within the cavernous sinus as early as 2 to 3 months postoperatively. Conclusion: Presently, the use of hemostatic agents and the better understanding of the microsurgical anatomy of the cranial base and cavernous sinus enable us to tame the cavernous sinus and operate in and around it with a high degree of safety.

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Gastric Tube-Pulmonary Fistula after Esophageal Reconstruction Treated by Endoscopic Fibrin Glue Injection: A Case Report.

The Japanese Journal of Gastroenterological Surgery ◽

10.5833/jjgs.34.329 ◽

2001 ◽

Vol 34 (4) ◽

pp. 329-333 ◽

Cited By ~ 1

Author(s):

Masashi Hanai ◽

Youichiro Kobayashi ◽

Kanji Miyata ◽

Fumihiko Yoneyama ◽

Tatsuo Hattori ◽

...

Keyword(s):

Case Report ◽

Fibrin Glue ◽

Gastric Tube ◽

Esophageal Reconstruction ◽

Glue Injection

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Merits of intralesional fibrin glue injection in surgery for the cavernous sinus cavernous hemangiomas

Journal of Neurosurgery ◽

10.3171/jns.2002.97.3.0718 ◽

2002 ◽

Vol 97 (3) ◽

pp. 718-721 ◽

Cited By ~ 21

Author(s):

Il-Man Kim ◽

Man-Bin Yim ◽

Chang-Young Lee ◽

Eun-Ik Son ◽

Dong-Won Kim ◽

...

Keyword(s):

Surgical Treatment ◽

Fibrin Glue ◽

Cavernous Sinus ◽

Content Type ◽

Cavernous Hemangiomas ◽

Novel Method ◽

Glue Injection ◽

Tumor Bleeding ◽

Fine Print ◽

Intratumoral Injections

✓ In planning surgical treatment for extraaxial cavernous hemangiomas, care should be taken to control severe tumor bleeding. The authors present a case of a large cavernous hemangioma of the cavernous sinus, which was completely removed with the aid of multiple intratumoral injections of fibrin glue. This novel method is very effective for preventing excessive blood loss during surgery for this type of lesion.

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Endoscopic debridement and fibrin glue injection of a chronic Morel-Lavallée lesion of the knee in a professional soccer player: A case report and literature review

The Knee ◽

10.1016/j.knee.2016.10.017 ◽

2017 ◽

Vol 24 (1) ◽

pp. 144-148 ◽

Cited By ~ 5

Author(s):

Baris B. Koc ◽

Nicolaas Somorjai ◽

Egid P.M. Kiesouw ◽

Kurt Vanderdood ◽

Marleen Meesters-Caberg ◽

...

Keyword(s):

Case Report ◽

Literature Review ◽

Fibrin Glue ◽

Soccer Player ◽

Professional Soccer ◽

Glue Injection ◽

Endoscopic Debridement ◽

Professional Soccer Player

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Extremely rare glioblastoma multiforme of the conus medullaris with holocord and brain stem metastases, leading to cranial nerve deficit and respiratory failure: a case report and review of the literature

Surgical Neurology ◽

10.1016/j.surneu.2004.08.044 ◽

2005 ◽

Vol 63 (6) ◽

pp. 576-582 ◽

Cited By ~ 25

Author(s):

Azedine Medhkour ◽

Michael Chan

Keyword(s):

Case Report ◽

Respiratory Failure ◽

Glioblastoma Multiforme ◽

Brain Stem ◽

Cranial Nerve ◽

Conus Medullaris ◽

Review Of The Literature ◽

Cranial Nerve Deficit

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The Use of Fibrin Glue to Stop Venous Bleeding in the Epidural Space , Vertebral Venous Plexus, and Anterior Cavernous Sinus: Technical Note

Operative Neurosurgery ◽

10.1227/01.neu.0000289711.95426.50 ◽

2007 ◽

Vol 61 (suppl_3) ◽

pp. ONS-E51-ONS-E51 ◽

Cited By ~ 12

Author(s):

Laligam N. Sekhar ◽

Sabareesh K. Natarajan ◽

Tom Manning ◽

Dolin Bhagawati

Keyword(s):

Fibrin Glue ◽

Cavernous Sinus ◽

Epidural Space ◽

Senior Author ◽

Technical Note ◽

Venous Plexus ◽

Baxter Healthcare ◽

Superior Petrosal Sinus ◽

Venous Bleeding ◽

Glue Injection

Abstract Objective: Various techniques have been used to stop venous bleeding from the epidural space, vertebral venous plexus, and cavernous sinus. Here, we describe our experience with the use of fibrin glue to stop venous bleeding in these areas. Methods: During the last 8 years, the senior author (LNS) has used injection of Tisseel fibrin glue (Baxter Healthcare Corp., Deerfield, IL) into the epidural space (n = 200 patients), anterior cavernous sinus (n = 46 patients), vertebral venous plexus (n = 20 patients), and superior petrosal sinus (n = 20 patients) to assist in hemostasis. The technical nuances are illustrated in three videos. Results: Injection of fibrin glue in the epidural space, anterior cavernous sinus, and vertebral venous plexus yielded good results in assisting with hemostasis. Two patients experienced complications caused by occlusion of veins draining the brainstem after fibrin glue was injected into the superior petrosal sinus. Conclusion: Fibrin glue injection is an excellent option for hemostasis in the epidural space, anterior cavernous sinus, and vertebral venous plexus. However, based on our experience, fibrin glue injection into the superior petrosal sinus is not recommended.

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Interdural cavernous sinus dermoid cyst in a child: case report

Journal of Neurosurgery Pediatrics ◽

10.3171/2016.9.peds1650 ◽

2017 ◽

Vol 19 (3) ◽

pp. 354-360 ◽

Cited By ~ 1

Author(s):

Flavio Giordano ◽

Giacomo Peri ◽

Giacomo M. Bacci ◽

Massimo Basile ◽

Azzurra Guerra ◽

...

Keyword(s):

Case Report ◽

Cavernous Sinus ◽

Cranial Nerve ◽

Nerve Palsy ◽

Lateral Wall ◽

Total Removal ◽

Pediatric Case ◽

Third Cranial Nerve Palsy ◽

The Right

Interdural dermoid cysts (DCs) of the cavernous sinus (CS), located between the outer (dural) and inner layer (membranous) of the CS lateral wall, are rare lesions in children. The authors report on a 5-year-old boy with third cranial nerve palsy and exophthalmos who underwent gross-total removal of an interdural DC of the right CS via a frontotemporal approach. The patient had a good outcome and no recurrence at the 12-month follow-up. To the best of the authors' knowledge this is the second pediatric case of interdural DC described in the literature.

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Effect of Fibrin Glue Injection Into the Cavernous Sinus for Hemostasis During Transcavernous Surgery on the Cerebral Venous Draining System

Operative Neurosurgery ◽

10.1227/neu.0000000000001324 ◽

2017 ◽

Vol 13 (2) ◽

pp. 224-231 ◽

Cited By ~ 4

Author(s):

Terushige Toyooka ◽

Naoki Otani ◽

Kojiro Wada ◽

Arata Tomiyama ◽

Hideaki Ueno ◽

...

Keyword(s):

Fibrin Glue ◽

Cavernous Sinus ◽

Venous Drainage ◽

Oxidized Cellulose ◽

Brain Swelling ◽

Drainage Pattern ◽

Injection Volume ◽

3 Dimensional ◽

Glue Injection ◽

Computed Tomography Venography

Abstract BACKGROUND: The extradural temporopolar transcavernous approach can be used to treat central skull base pathologies, but control of bleeding from the opened cavernous sinus is essential. Oxidized cellulose cotton packing and fibrin glue injection can be used, but the effect on the postoperative venous draining pattern remains unclear. OBJECTIVE: To investigate changes in the venous drainage pattern immediately after transcavernous surgery with and without fibrin glue injection into the bleeding cavernous sinus. METHODS: A total of 82 patients treated via the transcavernous approach were retrospectively divided into 2 groups based on the hemostasis methods. Both pre- and postoperative angiography and/or 3-dimensional computed tomography venography were available for 24 patients in the cotton packing group and 12 patients in the fibrin glue group. RESULTS: Postoperative change in the venous draining pattern was observed in 5 of the 24 patients in the cotton packing group and in 3 of the 12 patients in the fibrin glue group. One of the 82 patients showed postoperative brain swelling due to obstruction of the sphenoparietal sinus. The volume of injected fibrin glue ranged from 0.5 to 2.5 mL (mean, 1.1 ± 0.5 mL), but none of the patients had brain swelling. CONCLUSION: Direct fibrin glue injection into the opened cavernous sinus is relatively safe, but a change in the venous draining pattern occurs in 25% of patients. The study indicates the potential danger of the change in the venous draining pattern and recommends limiting the injection volume of fibrin glue in transcavernous surgery to avoid complications related to venous congestion.

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