gms | German Medical Science

Objective: Effective hemostasis is mandatory for excellent results in Neurosurgery. Microporous polysaccharide hemospheres (Arista^TM) are already available for neurosurgical application. The safety and efficacy of Arista was evaluated in different common neurosurgical procedures. Arista was used for hemostasis in emergency surgery of intracerebral hypertensive hemorrhages (ICH), brain tumor surgery (BT), intramedullary tumors (IMT) and chronic subdural hematomas (SDH).

Method: Since 2009, a total of 115 patients (55 ICH, 44 BT, 12 IMT and 4 SDH) underwent neurosurgical operative treatment. The final hemostasis was performed with Arista, a white powder compounded from potato starch. Hemostasis was video recorded and analyzed. Postoperative MRI or CT scans were used for volumetric measurements of secondary bleedings after surgery. Clinical examinations focused on bleeding tendency, use of coagulation influencing drugs and allergic reactions.

Results: The hemostatic powder was used in 115 surgical procedures showing good results. After evacuation of intracerebral hematomas, effective hemostasis was achieved very fast (mean time: 42 seconds, range: 8 to 252 seconds) by using Arista. In brain tumor and spinal cord surgery, effective hemostasis was achieved without using bipolar coagulation to avoid thermal side effects. 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, signs of allergic reactions or embolic complications were found. The postoperative and follow-up imaging excluded any expansive bleeding complication. Additionally, there was no tumor mimicking contrast enhancement in MRIs due to complete resorption of the powder.

Conclusions: Arista allows fast and cost-effective hemostasis in common neurosurgical procedures. The mechanism of hemostasis seems to be not influenced by blood coagulation inhibiting drugs. Save hemostasis in eloquent brain areas or spinal cord is possible without using bipolar coagulation. In our neurosurgical department, the application of Arista is established as an important technique for final hemostasis.