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Experiences with TachoSil® in microneurosurgery

  • Clinical Article - Neurosurgical Techniques
  • Published:
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Abstract

Background

We analyze our experience of using TachoSil® (Takeda Austria GmbH: Linz, Austria) in microneurosurgical procedures as a hemostat and also as a sealant to patch dural defects.

Materials and methods

Beginning on January 1, 2012, we prospectively analyzed 100 consecutive surgeries where TachoSil was used. The patient group included 58 women (58 %) and 42 men (42 %); the mean age was 52 years (range, 3–85 years). Indications for surgery included removal of the tumor (53 cases; 53 %), clipping of the cerebral arterial aneurysm (31 cases; 31 %), and treatment of other pathologies, including AVM (four cases; 4 %), cavernomas (four cases; 4 %), spinal tumor, and traumatic subdural hematoma. Patients received postoperative care according to local neurosurgical department protocol, including a postoperative CT scan after each craniotomy. Primary assessment of the wound took place during the hospital stay as well as at discharge or transfer to a rehabilitation unit. Mean follow-up time was 4 months (range, 1–12 months).

Results

None of the patients developed postoperative hematoma after craniotomy or spinal procedure. At primary assessment during hospital stay, 93 patients (93 %) had had no wound-related problems over the normal course of healing. No case registered any liquor leak from the wound, and none of the patients showed any signs of allergic response related to TachoSil usage. At the last follow-up, 96 patients (96 %) experienced uneventful wound healing, and in four patients (4 %), superficial wound infection was successfully treated with oral antibiotics.

Conclusions

Our results indicate that TachoSil can serve in neurosurgical practice at no additional risks. TachoSil proved to be an effective hemostat, sealant, and adhesive in either cranial or spinal procedures.

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Conflicts of interest

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Authors and Affiliations

  1. Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland

    Juri Kivelev, Felix Göhre, Mika Niemelä & Juha Hernesniemi

  2. Department of Neurosurgery, Helsinki University Central Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland

    Juri Kivelev

Authors
  1. Juri Kivelev
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  2. Felix Göhre
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  3. Mika Niemelä
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  4. Juha Hernesniemi
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Corresponding author

Correspondence to Juri Kivelev.

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Comments

The authors’ experience with TachoSil matches that of our department. We too have used TachoSil extensively over the last 2 years in a similar range of operations, mainly for dural repair and as a cover for mastoid air cells. In addition, we have found it useful for sealing “weeping” arachnoid in transsphenoidal procedures. The surgical closure time is markedly reduced and the need for various patches is obviated. The authors also describe their experience with TachoSil for tumor bed hemostasis and how to avoid inadvertent detachment of the material, a technique that I am looking forward to trying. The safety profile of TachoSil appears to be sound, including the appropriate caveats of the authors. We must, however, remember that this series is anecdotal. Comparative studies to other dural closure techniques will be difficult and costly to organize due to the low incidence of CSF leakage in most supratentorial procedures. Infratentorial craniotomies that have a higher incidence of CSF complications may serve in a comparative evaluation of the utility of the product in the future. The high price of the product does limit its routine usage, though the company will soon be providing smaller patches at a lower price.

Zvi Harry Rappaport

Petah Tiqva, Israel

When I first saw the title of this article, I believed this was a topic that was covered extensively already. Rather surprisingly, I found that it is not. In the present article, the authors simply give us an account of their experience with the use of TachoSil, which appears to be of value for avoiding CSF leaks and in the closure of openings of the ventricular wall, etc. In my opinion, the most valuable information lies in the many practical tricks and tips they present in the Discussion section, e.g., on how to handle the pieces of sealant in the field.

Knut Wester

Oslo, Bergen

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Kivelev, J., Göhre, F., Niemelä, M. et al. Experiences with TachoSil® in microneurosurgery. Acta Neurochir 157, 1353–1357 (2015). https://doi.org/10.1007/s00701-015-2473-x

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  • DOI: https://doi.org/10.1007/s00701-015-2473-x

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