ABSTRACT
A major concern in surgery is the prevention or control of bleeding. The ligature and the clip are the hallmarks of the last century of modern surgery. Therapeutic embolization is not really used to stop hemorrhage but to treat aneurysms and so prevent future rupture and bleeding. Blood clotting within the network of coils of the now widely used Guglielmi detachable coils is now progressively becoming the method of choice whenever possible in aneurysm treatment. Simple external compression at a pressure higher than the intravascular pressure can control bleeding, and if continued long enough, may cause clotting in the bleeding vessels. Unfortunately, there are few areas in the central nervous system where such pressure can be applied, although it is a considerable help in opening muscle layers where self-retaining retractors will be used. Low-pressure venous bleeding may be controlled by application of gelfoam, surgically, or a bit of crushed muscle supported temporarily by a wet cottonoid pledget without occlusion of the venous channel. Historically, hot actual cautery or boiling oil were used to achieve hemostasis by forming a large tissue coagulum, which usually prevented bleeding until the entire dead mass sloughed away.
Subject(s)
Brain Diseases/surgery , Electrosurgery/instrumentation , Electrosurgery/methods , Embolization, Therapeutic/instrumentation , Electrosurgery/history , Embolization, Therapeutic/adverse effects , History, 20th Century , Humans , Postoperative ComplicationsABSTRACT
OBJECT: The goal of this study was to summarize the author's personal experience in the surgical treatment of 19 patients with intramedullary spinal cord hemangioblastomas. METHODS: All cases were from the author's private practice and were treated between 1967 and 1990. In all cases the intramedullary hemangioblastomas were totally removed by using a unique microsurgical technique of bipolar coagulation, which is fully described in this paper. A bipolar forceps was used to shrink each tumor and detach it from its feeding and draining vessels. Tumor resection was successfully accomplished in all patients. Blood loss was minimal, averaging less than 100 ml, and what little bleeding occurred did so during laminotomy or laminectomy. No bleeding occurred during tumor removal, and no transfusions were given. All patients were symptomatic preoperatively, and all recovered or improved following surgery. CONCLUSIONS: The technique described in this paper makes tumor removal safe, effective, and relatively easy.
