It is quite common complains of every neurosurgeons reporting excessive blood loss. preoperative work up for coagulation profile assessment is very important. preoperative embolization of intracranial tumor. proper head up position, proper airway patency avoidance of excessive head rotations, proper control of mean arterial pressure, use of intravenous anaesthetic agent, control of raised intracranial pressure with mannitol infision,tapping of cyst or placement of external ventricular drain or adequate size craniotomy, placement of lumbar drain or even staging of surgical procedure or looking for excessive herniation of brain matter,or watching for development of ipsilateral or contralateral EDH or SDH, intraoperative adequate replacement of FFP, PRP or application of biological glue or flowseal is usually routinely practised.
- Tranexamic acid - bolus and/or infusion
- Hydrogen peroxide
- Avoiding volume overload - Coagulopathy due to hemodilution is a silent killer
- Judicious use of temporary clipping of feeding artery
- Keeping cool under stress - trying too hard to control bleeding with bipolar cauterization can be detrimental. Simple irrigation and 'waiting out' with tamponade works for most oozes
Many-many thanks Dr Adhikari for valuable answer and further extending discussion.
You answered every thid, using lidocaine infiltration to the marked insicion site, minimizing craniotomy flap as much as possible according to the pathology, using bone wax vigorously in dealing bone especially in meningiomas, spending more time for cauterization in each step from skin incision till dura opening
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