gms | German Medical Science

Objective: Effective hemostasis is mandatory for excellent results in brain tumor surgery. Microporous polysaccharide hemospheres (MPH®, Arista-AH™) are already available for surgical and emergency purposes. This is the first study evaluating the safety and efficacy of Arista in neurosurgery.

Methods: Thirty-three patients (mean age 58 y, range 22 to 84 y) underwent microsurgical brain tumor resection. The final hemostasis was performed with Arista. Arista is a white powder compounded from potato starch. Hemostasis was video-recorded and analyzed. Blood samples were taken before the operation, prior to Arista application and after the operation. Volume measurement of tumor size, resection cavity and postoperative hematoma were evaluated according to MRI- and CT-scans. Clinical examinations were focused on neurological outcome and allergic reactions.

Results: Effective hemostasis was achieved by the exclusive use of Arista in 32 patients. In one patient, a single arterial bleeding had to be treated with additional bipolar electrocautery. Mean operative time was 156.8 min (60 to 235 min). Complete hemostasis was achieved within an average time of 272 sec (range 28 to 944 sec). Subjective ranking of the hemostasis effect resulted in excellent satisfaction of the neurosurgeons. During a follow-up period of 3 months, no Arista related postoperative neurological complication or signs of allergic reaction or embolic complication were seen. Early postoperative MRI- or CT-scan and 3-month follow-up excluded any expansive bleeding complication. Arista was not detectable anymore and there was no tumor-mimicking contrast-enhancement.

Conclusions: In neurosurgery, Arista allows fast and effective, minimally-invasive and cost-effective hemostasis. In this small case series, no adverse reactions were found.