Achieving hemostasis in delicate areas can be a challenge for the neurosurgeon.In addition to using meticulous technique to prevent bleeding,topical agents are routinely used as an adjunct to hemostasis.Some hemostatic products form a composite clot that seals a bleeding site by using a thrombin component that converts fibrinogen in the patient's blood to fibrin.Select the two hemostatic products that provide hemostasis by topical application,essentially acting as a patch rather than a clotting factor.

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Bone wax is a hemostatic material that should be available for all cranial and spinal cord operations.Bone wax may be applied with the surgeon's fingertip or with the tip of an instrument such as a Freer or Penfield elevator.The surgeon firmly rubs or packs the wax into the bleeding surfaces of bone.Bone wax is commonly used in burr holes,along the edges of a craniotomy,and on the cut edges of the spine.Oxidized regenerated cellulose is available in two forms: a rayon-like gauze and a cotton-like form.These are also absorbable hemostatic agents that are used to control bleeding from oozing surfaces,vessels,and sinuses in the brain.These hemostatic substances are presented in various sizes and shapes and are offered to the surgeon dry.The hemostatic material adheres to the bleeding area with gentle pressure.

Achieving Hemostasis in Delicate Areas Can Be a Challenge for the Neurosurgeon.In