Ceren KIZMAZOGLU, Orhan KALEMCİ, Koray UR, Goktug AKYOLDAS, Ayca Ersen DANYELİ, Onur ACIS, Mehmet Nuri ARDA

The investigation of vasospastic effect of hemostatic matrix used in intracranial operations on cerebral arteries

Aim: We aimed to investigate the vasospastic effect of thrombin-based hemostatic matrix on the basilar arteries in rats.Material and Methods: A total of 28 female albino Wistar rats were used in the study. The rats were randomly assigned to fourgroups. The rats in group I (control group) were sacrificed without surgical manipulation. We injected 0.1 mL of nonheparinizedautologous arterial blood into the cisterna magna of the rats in group II, 0.1 mL of hemostatic matrix into the cisterna magna of therats in group III, and 0.1 mL of a mixture of nonheparinized autologous arterial blood and the hemostatic matrix into the cisternamagna of the rats in group IV. The experimental rats were sacrificed 48 hours after injections. Three sections were obtained fromeach rat’s basilar arteries and photographed under a light microscope. Basilar artery cross-section areas were measured usingcomputerized image analysis systems.Results: Mean basilar artery cross-sections of all groups revealed statistically a significant difference between only group I andgroup II. The mean basilar artery cross-sec-tion areas of groups II, III, and IV decreased by 36%, 19%, and 22%, respectively, incomparison with those of group I.Conclusion: Although our results pertaining to thrombin-based hemostatic matrix were not statistically significant, it is hypothesizedthat this matrix has a vasospastic effect on arteries. Therefore, it important to remember that when such a matrix is used in cranialsurgery, the thrombin contained therein could have a vasospastic effect on cerebral arteries.

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1. Takayama M, Kashiwagi M, Hara K, et al. Basal subarachnoid hemorrhage by rupture of arteriovenous malformation at the cerebellopontine angle. Neuropathology 2017;37:441-44.
2. deSouza RM, Shah M, Koumellis P, et al. Subarachnoid haemorrhage secondary to traumatic intracranial aneurysm of the posterior cerebral circulation: case series and literature review. Acta Neurochir (Wien) 2016;158:1731-40.
3. Tan D, Daly C, Xenos C, et al. Glioblastoma presenting as spontaneous subarachnoid hemorrhage: a technical case note of combined endovascular and microsurgical vision sparing treatment. World Neurosurg 2019;128:426-30.
4. Chaichana K, Riley LH 3rd, Tamargo RJ. Delayed cerebral vasospasm secondary to bacterial meningitis after lumbosacral spinal surgery: case report. Neurosurgery 2007;60:E206-01.
5. Lee J, Sagher O, Keep R, et al. Comparison of Experimental Rat Models of Early Brain Injury after Subarachnoid Hemorrhage. Neurosurgery 2009;65:331-43.
6. Weir BKA, Macdonald RL, Stoodley M. Etiology of cerebral vasospasm. Acta Neurochir (Wien) 1999;72:27-46.
7. Hirano K, Hirano M. Current Perspective on the Role of the Thrombin Receptor in Cerebral Vasospasm After Subarachnoid Hemorrhage. J Pharmacol Sci 2010;114:127- 33.
8. Fiss I, Danne M, Stendel R. Use of gelantin-thrombin matrix hemostatic sealant in cranial neurosurgery. Neurol Med Surg 2007;47:462-7.
9. Breda A, Stepanian SV, Lam JS, et al. Use of haemostatic agents and glues during laparoscopic partial nephrectomy: a multi-institutional survey from the United States and Europe of 1347 cases. Eur Urol 2007;52:798-803
10. Oz MC, Cosgrove DM 3rd, Badduke BR, et al. Controlled clinical trial of a novel hemostatic agent in cardiac surgery. Ann Thorac Surg 2000;69(5):1376-82.
11. Cappabianca P, Esposito F, Esposito I, et al. Use of a thrombingelatin haemostatic matrix in endoscopic endonasal extended approaches: technical note. Acta Neurochir (Wien) 2009;151:69-77.
12. Muzii L, Perniola G, Plotti F. A new technique for laparoscopic stripping of endometrioma: FloSeal hemostatic agent for hemostasis of the ovarian wall. J Minim Invasive Gynecol 2007;14:S130.
13. Solomon RA, Antunes JL, Chen RY, et al. Decrease in cerebral blood flow in rats after experimental subarachnoid hemorrhage: a new animal model. Stroke 1985;16:58-6.
14. Durrant JC, Hinson HE. Rescue therapy for refractory vasospasm after subarachnoid hemorrhage. Curr Neurol Neurosci Rep 2015;15:521.
15. Bauer AM, Rasmussen PA. Treatment of intracranial vasospasm following subarachnoid hemorrhage. Front Neurol 2014;5:72.
16. Francoeur CL, Mayer SA. Management of delayed cerebral ischemia after subarachnoid hemorrhage. Crit Care 2016;20:277.
17. Li K, Barras CD, Chandra RV, et al. A review on the management of cerebral vasospasm following aneurysmal subarachnoid haemorrhage. World Neurosurg 2019;126:513-27.
18. Kim JH, Yi HJ, Ko Y, et al. Effectiveness of papaverine cisternal irrigation for cerebral vasospasm after aneurysmal subarachnoid hemorrhage and measurement of biomarkers. Neurol Sci 2014;35:715-22.
19. Prunell GF, Svendgaard N, Alkass K, et al. Inflammation in the Brain After Experimental Subarachnoid Hemorrhage. Neurosurgery 2005;56:1082-92.
20. Li G, Wang Q, Lin T, et al. Effect of thrombin injection on cerebral vascular in rats with subarachnoid hemorrhage. J Int Med Res 2019;14:2819-31.
21. Gazzeri R, Galarza M, Neroni M, et al. Minimal craniotomy and matrix hemostatic sealant for the treatment of spontaneous supratentorial intracerebral hemorrhage. J Neurosurg 2009;110:939-42.
22. Renkens KL Jr, Payner TD, Leipzig TJ, et al. A multicenter, prospective, randomized trial evaluating a new hemostatic agent for spinal surgery. Spine (Phila Pa 1976) 2001;26:1645- 50.
23. Luh HT, Huang AP, Yang SH, et al .Local hemostatic matrix for endoscope-assisted removal of intracerebral hemorrhage is safe and effective. J Formos Med Assoc 2018;117:63-70.
24. Delgado T, Brismar J, Svendgaard NA. Subarachnoid haemorrhage in the rat: Angiography and fluorescence microscopy of the major cerebral arteries. Stroke 1985;16,595-602.
25. Gules I, Satoh M, Clower BR, et al. Comparison of three rat models of cerebral vasospasm. Am J Physiol Heart Circ Physiol 2002;283:H2551-9.
26. Kasuya H, Shimizu T, Takakura K. Thrombin activity in CSF after SAH is correlated with the degree of SAH, the persistence of subarachnoid clot and the development of vasospasm. Acta Neurochir (Wien) 1998;140:579-84.
27. Suzuki M, Kudo A, Otawara Y, et al. Extrinsic pathway of blood coagulation and thrombin in the cerebrospinal fluid after subarachnoid hemorrhage. Neurosurgery 1999;44:487-93.