Use of a contoured bioresorbable plate with a hemostatic plug to control life-threatening bleeding from the superior sagittal sinus during hemispherotomy: technical note

Profuse bleeding originating from an injured cerebral sinus can be a harrowing experience for any surgeon, particularly during an operation on a young child. Common surgical remedies include sinus ligation, primary repair, placement of a hemostatic plug, and patch or venous grafting that may require temporary stenting. In this paper the authors describe the use of a contoured bioresorbable plate to hold a hemostatic plug in place along a tear in the inferomedial portion of a relatively inaccessible part of the posterior segment of the superior sagittal sinus in an 11-kg infant undergoing hemispherotomy for epilepsy. This variation on previously described hemostatic techniques proved to be easy, effective, and ultimately lifesaving. Surgeons may find this technique useful in similar dire circumstances when previously described techniques are ineffective or impractical.

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Management of inadvertent injury to superior sagittal sinus in parasagittal meningioma: technical note

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2015.196 ◽

2015 ◽

Vol 42 (S1) ◽

pp. S43-S43

Author(s):

AA Ahmed ◽

B Yarascavitch ◽

N Murty

Keyword(s):

Surgical Resection ◽

Superior Sagittal Sinus ◽

Lateral Wall ◽

Technical Note ◽

Venous Sinus ◽

Sagittal Sinus ◽

Sinus Wall ◽

Venous Wall ◽

Parasagittal Meningioma ◽

Tamponade Effect

Background: Parasagittal meningioma is a common type of intracranial meningiomas. Surgical resection of such lesions can result in injury to superior sagittal sinus. In rare occasions, extended craniotomy might be required for uncontrollable hemorrhage from a lacerated venous wall. Objective: In order to avoid extended craniotomy, we attempted a surgical technique that would provide more sustained control over the lacerated venous sinus. Method: A 56 year old lady underwent surgical resection for parasagittal meningioma. The lateral wall of the superior sagittal sinus was preached while scraping the tumor capsule from the sinus wall. Owing to difficulty in controlling the bleeding site, a tack up falx-assisted tension suture was attempted with a mass of Gelfoam and Surgicel over the laceration. Results: Adequate control for the venous sinus laceration. Conclusion: The falx-assisted suturing technique is quick, easy to perform and efficient in maintaining a constant tamponade effect over the lacerated site. We highly recommend such technique prior to extending the craniotomy over an injured venous sinus.

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Surgical Superior Sagittal Sinus Thrombectomy in Refractory Thrombosis: A Technical Note

Pediatric Neurosurgery ◽

10.1159/000495808 ◽

2019 ◽

Vol 54 (3) ◽

pp. 212-217 ◽

Cited By ~ 1

Author(s):

Harrison J. Westwick ◽

Sami Obaid ◽

Frederique Bordeleau-Roy ◽

Eric Truffer ◽

Alexander G. Weil

Keyword(s):

Superior Sagittal Sinus ◽

Technical Note ◽

Sagittal Sinus

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Optimizing Burr Hole Placement for Craniotomy: A Technical Note

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0039-1695699 ◽

2019 ◽

Vol 10 (03) ◽

pp. 413-416 ◽

Cited By ~ 1

Author(s):

Survendra Kumar Rajdeo Rai ◽

Saswat Kumar Dandpat ◽

Dikpal Jadhav ◽

Shashi Ranjan ◽

Abhidha Shah ◽

...

Keyword(s):

Superior Sagittal Sinus ◽

Technical Note ◽

Burr Hole ◽

Bone Flap ◽

Sagittal Sinus ◽

Large Size ◽

Good Cosmesis ◽

Burr Holes ◽

Minimum Numbers ◽

Smooth Margin

Abstract Objective Usually, burr holes are placed along the line of a craniotomy. We describe a novel technique of burr hole placement to obtain smooth and beveled bony margin without any troughs and crests. Dural separation is obtained by minimizing the number of burr holes required. Methods Fifty craniotomies of diameter ranging from 3.5 to 11.5 cm were accomplished by placing burr hole in the center of bone flap rather than along the craniotomy line permitting 360 degrees of dura separation dependent on the length of dura separator. Craniotomy < 9 cm in diameter was performed by placing a single burr hole and a larger size craniotomy was performed with two burr holes. Parasagittal craniotomy was performedby placing burr hole not > 2.5 cm away from expected craniotomy site, namely superior sagittal sinus area enabling separation of adhered dura and venous sinuses. The bone cutter was used in a particular fashion to create smooth margin and beveled edges. Results Craniotomy < 9 cm in diameter was possible with single burr hole in 34 cases. Craniotomy larger than 9 cm in size was performed in 16 cases with double burr hole by strategically placing burr in the center of the desired bone flap. The craniotomy was achieved in all cases without damaging dura and venous structures. Conclusions An optimally placed single burr hole is sufficient for small to moderately large size craniotomy. Larger size craniotomy is possible with minimum numbers of burr holes. This achieves good cosmesis and avoids sinking of the bone flap.

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