gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

Recombinant activated factor seven for treatment of massive bleeding during paediatric brain tumour surgery

Rekombinanter aktivierter Faktor VII für die Behandlung massiver intraoperativer Blutungen bei Hirntumoroperationen im Kindesalter

Meeting Abstract

  • corresponding author A. M. Messing-Jünger - Neurochirurgische Klinik, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Düsseldorf
  • C. Sucker - Institut für Hämostaseologie und Transfusionsmedizin, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Düsseldorf
  • M. Hartmann - Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. DocP136

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2005/05dgnc0404.shtml

Veröffentlicht: 4. Mai 2005

© 2005 Messing-Jünger et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

In rare cases large pediatric brain tumors need to be operated as emergencies due to decompensated high intracranial pressure. Highly vascularized tumors can lead to life threatening bleedings during surgery, but presurgical embolisation of tumor vessels is not possible in such cases. Recombinant activated factor seven can control excessive tumoral bleeding during surgery.

Methods

Two children with large, hypervascularized supratentorial tumors with massive intraoperative bleeding are presented in a double case report.

Results

A 9-year-old child presented with a giant glioblastoma. The tumor was not present 2 yrs ago. Due to NF 1 the girl was regularily followed by our pediatricians. MRI and CT demonstrated a large tumor mass occupying most of the left hemisphere with extracranial tumor vascularization. Due to decompensated intracranial pressure immediate surgical debulking became necessary. Preoperative evaluation showed normal apt, Quick and thrombocyte count. Due to massive intratumoral bleeding a total blood loss of 25 l was substituted with erythrocyte and thrombocyte concentrates and fresh frozen plasma. The fibrinolytic system was inhibited with 1 Mio units of aprotinin, hypothermia was avoided. However, despite normal bed side tests and a normal platelet count massive diffuse bleeding persisted. After application of 120 KIE of recombinant activated factor VIIa twice within 30 minutes blood loss markedly slowed down and finally haemostasis was achieved. A 14 year old girl presented with signs of increased cranial pressure and following decompensation. 10 yrs ago the child had been treated for acute lymphatic leucemia with polychemotherapy and radiation of the neurocranium.The last aftercare 3 months ago was without pathological findings. CT and MRI demonstrated a large cystic brain tumor in the right hemisphere suspicious of glioblastoma as a typical second tumor. The child was scheduled for emergency surgery. Preoperative coagulation parameters as well as thrombocyte count were normal. A blood loss of approximately 5 l was substituted and the fibrinolytic system was inhibited with aprotinin. Coagulation parameters were normal, but diffuse bleeding persisted. Again we applied 240 KIE of recombinant activated factor VIIa. Within 10 minutes the microvascular bleeding stopped without further surgical manipulations.

Conclusions

In paediatric neurosurgery the use of recombinant factor VIIa should be considered in otherwise untreatable microvascular bleeding.