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Oxidized cellulose hemostat (Surgicel)
Surg Neurol 1984;21:521-2
521
Editorial Oxidized Cellulose Hemostat (Surgicel) I have recently reread the section in the Physician's Desk Reference (PDR) (27th Ed. Orodell, N.J.: Medical Economics, 1983:1031-2) on Surgicel (oxidized cellulose hemostat). T h e occasion was an article "Compressive optic neuropathy following use of intracranial oxidized cellulose hemostat" (Ophthalmic Surg 1983; 14:487-90) by J.J. Dutton, D.T. Tse, and R.L. Anderson. This material (Surgicel) was placed into the anterior cranial fossa for hemostasis during neurosurgical repair of a frontotemporal skull fracture and lacerated left frontal lobe in a 35-year-old man who had been injured in a m o t o r vehicle accident. Rapid deterioration of vision to absence of light perception followed 48 hours after operation. Radiologic and echographic evaluation indicated a soft-tissue density in the orbital apex; when the optic canal was opened, the cellulose hemostat was found in the left orbital apex, having migrated through orbital r o o f fractures. Removal of this material resulted in return o f vision to the level of counting fingers. My first exposure to this type of compression of neural structures was in review of a medicolegal brief having to do with paraplegia resulting from a wad of Surgicel placed in the intervertebral foramen to control bleeding in a patient from w h o m a thoracic neurofibroma had
been removed. At the University of Illinois, we later had a similar case of intraspinal mass from use of Surgicel. T h e Product Information in the P D R includes the following information: "When S U R G I C E L is used to help achieve hemostasis around the spinal cord in laminectornies, or around the optic nerve and chiasm, it must always be r e m o v e d after hemostasis is achieved since it will swell and could exert unwanted pressure." In a later segment under Warnings, the statement reads: "It must always be removed from the site of application after use in laminectomy procedures and from foramina in bone when hemostasis is obtained. This is because S U R G I C E L , by swelling, may cause nerve damage by pressure in a bony confine. Paralysis has been reported when used around the spinal cord, particularly in surgery for herniated intervertebral disc." This material is very useful in hemostasis, and in contrast to other hemostatic agents, is also bacteriocidal in vitro against many organisms and does not tend to enhance experimental infection. Let's be careful with this material, useful when properly applied. OSCAR SUGAR Chicago, Illinois
$10,000 T h e past 15 years have seen great advances in neurological surgery. Today we are able to treat successfully many conditions that could not be treated before. Why? T h e answer is research, laboratory and clinical research. T h e r e are still a n u m b e r of unsolved problems. Practically all patients with cerebral gliomas still die from their tumors. Far too many patients with intracranial aneurysms develop serious cerebral vasospasm, which we can neither prevent nor treat. T o o many patients with fractured spines either b e c o m e paralyzed or remain paralyzed. These are but some o f the neurosurgical problems that are not being adequately met. Yet there is something that every neurological surgeon can do about it. A few years ago Dr. R o b e r t B. King started the Research Foundation of the American Association of © 1984 by Elsevier Science Publishing Co., Inc.
Neurological Surgeons. This Foundation was established to assist young neurological surgeons in obtaining training in research. We must have more young people trained in research if the problems are to be m e t and solved. The Foundation has fared very well but its financial goal has not yet been met. Some neurological surgeons have been generous in making donations to this tax-exempt Foundation, but not enough. Every neurological surgeon who has not done so should make a donation. Many of them could easily donate $10,000 as these donations are deductible from their income-tax returns. Pledges may be extended over a 1- to 5-year payment period. All neurological surgeons are not able to do productive research, but all neurological surgeons can donate 0090-3019/84/S3.0()
521
Editorial Oxidized Cellulose Hemostat (Surgicel) I have recently reread the section in the Physician's Desk Reference (PDR) (27th Ed. Orodell, N.J.: Medical Economics, 1983:1031-2) on Surgicel (oxidized cellulose hemostat). T h e occasion was an article "Compressive optic neuropathy following use of intracranial oxidized cellulose hemostat" (Ophthalmic Surg 1983; 14:487-90) by J.J. Dutton, D.T. Tse, and R.L. Anderson. This material (Surgicel) was placed into the anterior cranial fossa for hemostasis during neurosurgical repair of a frontotemporal skull fracture and lacerated left frontal lobe in a 35-year-old man who had been injured in a m o t o r vehicle accident. Rapid deterioration of vision to absence of light perception followed 48 hours after operation. Radiologic and echographic evaluation indicated a soft-tissue density in the orbital apex; when the optic canal was opened, the cellulose hemostat was found in the left orbital apex, having migrated through orbital r o o f fractures. Removal of this material resulted in return o f vision to the level of counting fingers. My first exposure to this type of compression of neural structures was in review of a medicolegal brief having to do with paraplegia resulting from a wad of Surgicel placed in the intervertebral foramen to control bleeding in a patient from w h o m a thoracic neurofibroma had
been removed. At the University of Illinois, we later had a similar case of intraspinal mass from use of Surgicel. T h e Product Information in the P D R includes the following information: "When S U R G I C E L is used to help achieve hemostasis around the spinal cord in laminectornies, or around the optic nerve and chiasm, it must always be r e m o v e d after hemostasis is achieved since it will swell and could exert unwanted pressure." In a later segment under Warnings, the statement reads: "It must always be removed from the site of application after use in laminectomy procedures and from foramina in bone when hemostasis is obtained. This is because S U R G I C E L , by swelling, may cause nerve damage by pressure in a bony confine. Paralysis has been reported when used around the spinal cord, particularly in surgery for herniated intervertebral disc." This material is very useful in hemostasis, and in contrast to other hemostatic agents, is also bacteriocidal in vitro against many organisms and does not tend to enhance experimental infection. Let's be careful with this material, useful when properly applied. OSCAR SUGAR Chicago, Illinois
$10,000 T h e past 15 years have seen great advances in neurological surgery. Today we are able to treat successfully many conditions that could not be treated before. Why? T h e answer is research, laboratory and clinical research. T h e r e are still a n u m b e r of unsolved problems. Practically all patients with cerebral gliomas still die from their tumors. Far too many patients with intracranial aneurysms develop serious cerebral vasospasm, which we can neither prevent nor treat. T o o many patients with fractured spines either b e c o m e paralyzed or remain paralyzed. These are but some o f the neurosurgical problems that are not being adequately met. Yet there is something that every neurological surgeon can do about it. A few years ago Dr. R o b e r t B. King started the Research Foundation of the American Association of © 1984 by Elsevier Science Publishing Co., Inc.
Neurological Surgeons. This Foundation was established to assist young neurological surgeons in obtaining training in research. We must have more young people trained in research if the problems are to be m e t and solved. The Foundation has fared very well but its financial goal has not yet been met. Some neurological surgeons have been generous in making donations to this tax-exempt Foundation, but not enough. Every neurological surgeon who has not done so should make a donation. Many of them could easily donate $10,000 as these donations are deductible from their income-tax returns. Pledges may be extended over a 1- to 5-year payment period. All neurological surgeons are not able to do productive research, but all neurological surgeons can donate 0090-3019/84/S3.0()