A bronchial artery embolization (BAE) is an important therapeutic method used to control acute and chronic hemoptysis. We report a case of multiple micro-infarcts involving both the kidneys and spleen, following a BAE with 500-700 micrometer crossed-linked tris-acryl microspheres (Embospheres) in a patient with bronchial artery pulmonary vein shunts. The superior penetration characteristics of the microspheres may have resulted in the greater tendency to cross the bronchial artery pulmonary vein shunts, which subsequently caused the systemic infarcts in our patient. We propose the use of larger sized microspheres (700-900 micrometer), which may aid in avoiding this complication.
Acrylic Resins/*adverse effects/therapeutic use ; Adult ; *Bronchial Arteries ; Embolization, Therapeutic/*adverse effects ; Female ; Gelatin/*adverse effects/therapeutic use ; Hemoptysis/therapy ; Humans ; Infarction/*etiology/radiography ; Kidney/*blood supply ; Splenic Infarction/*etiology/radiography

OBJECTIVETo introduce a new principle of sellar reconstruction and to evaluate the effectiveness of absorbable gelatin foam and fibrin glue for sellar reconstruction.

METHODSA total of 176 consecutive patients who underwent surgery for pituitary adenomas, cysts, chordomas, or subdiaphragmatic craniopharyngiomas in the sella turcica between January 2001 and April 2003 at Peking Union Medical College Hospital were enrolled. Different techniques of sellar closure and indications for each specific condition were retrospectively reviewed.

RESULTSSeventy-seven (43.7%) patients developed a visible cerebrospinal fluid (CSF) leakage during surgery. Intra-operative CSF leakage were repaired simply with gelatin foam and fibrin glue in 62 (35.2%) patients, and with autologous fat graft and sellar floor reconstruction in 15 (8.5%) patients. Postoperative CSF rhinorrhea occurred only in 1 case. There were no visual deterioration, allergic rhinitis, meningitis, pneumocranium, granulomas, or other complications associated with the reconstruction procedure.

CONCLUSIONThe procedure of using gelatin foam and fibrin glue and principle of cranial base reconstruction is safe and effective in preventing postoperative complications following transsphenoidal surgery.

Adenoma ; surgery ; Adolescent ; Adult ; Aged ; Central Nervous System Cysts ; surgery ; Cerebrospinal Fluid Rhinorrhea ; etiology ; surgery ; Craniopharyngioma ; surgery ; Female ; Fibrin Tissue Adhesive ; therapeutic use ; Follow-Up Studies ; Gelatin Sponge, Absorbable ; therapeutic use ; Humans ; Hypophysectomy ; methods ; Male ; Middle Aged ; Pituitary Neoplasms ; surgery ; Reconstructive Surgical Procedures ; adverse effects ; methods ; Retrospective Studies ; Sella Turcica ; surgery ; Tissue Adhesives ; therapeutic use