Neurosurgery — hemostasis on dura and pia mater
Bleeding control during craniotomy, tumour resection, endonasal skull-base surgery, and spinal surgery. Neutral pH and high molecular weight matter when working next to neural tissue.
Bleeding in neurosurgery
Intracranial hemostasis is anatomically constrained: the space is closed, packing can cause mass effect and compression, and thermal energy from electrocautery is risky next to functional cortex. Bleeding sources include dura, cortex, venous sinuses, epidural and subdural compartments. A resorbable topical hemostat is a mandatory part of the protocol, especially in deep and brainstem operations.
Sources of intracranial bleeding
Each source needs its own tactic — vessel ligation isn't always possible, so a topical hemostat acts as an adjunct
Dura mater
Meningeal arteries (a. meningea media), emissary veins. Bipolar coagulation plus a resorbable hemostat on the dural-incision edges.
Cortex and parenchyma
Capillary ooze from the surface after tumour resection or corticotomy. Bipolar coagulation is limited by thermal damage to the adjacent cortex — a hemostatic matrix is preferred.
Venous sinuses
Sagittal, transverse, sigmoid sinus. Ligation is not an option — it triggers oedema or venous infarct. Standard tactic — compression plus a hemostatic matrix with known neutral pH.
Spinal cord and epidural space
Epidural venous plexus during laminectomy, spinal cord tumours. Packing is canal-space-limited — need materials that don't swell or compress nerve roots.
Principles of neurosurgical hemostasis
Minimal thermal load
Low-power bipolar coagulation with saline irrigation — only on a pinpointed vessel. Diffuse ooze is better controlled by a matrix.
Neutral pH near neurons
Acidic hemostats (oxidised regenerated cellulose with pH ≤ 3) can irritate and slow lysis when they touch neural tissue. Materials with near-physiological pH are safer.
No embolic risk
Hemostat molecular weight must be high enough to prevent transmural passage into the bloodstream and distal embolisation — critical when working with dural sinuses and large arteries.
No pressure on the brain
The material should form a thin non-swelling gel without volumetric load — no swelling collagen sponges or long-compression packs.
BloodSTOP iX®'s role
BloodSTOP iX® fits neurosurgery especially well: neutral pH 7.2 (vs Surgicel® pH 3.1), molecular weight over 120 000 Da — the material can't pass through vessel walls and won't embolise. Resorption in 1–4 weeks without swelling or mass effect. Suitable on dura, cortex, sinuses, and spinal cord. Per manufacturer data, clinical studies report 0% rebleeding.
BloodSTOP iX 5×5 cm
Pinpoint cortical bleeding, emissary veins, small-diameter craniotomy windows.
BloodSTOP iX 10×5 cm
Dural sinuses, epidural plexus in laminectomy, tumour bed.
BloodSTOP iX 10×20 cm
Large operating field — extensive resection, diffuse ooze after tumour removal.
Reference literature
Oxidised regenerated cellulose in surgery — 50 years of use
Lewis K.M. et al. · Surgery · 2013
On requestBiodegradable materials for bleeding control — review
Yan T., Zhang W. et al. · Bioactive Materials · 2022
On request
Further reading
More on the manufacturer's site
LifeScience Plus maintains a detailed topic page with clinical cases. Opens in a new tab.