Hemostatic Outcomes to Use Surgiflo Thrombin in Oncologic and Skull Base Neurosurgery: A Retrospective Cohort Analysis

Introduction: In healthcare systems like ours, characterized by limited resources and strict expenditure oversight, the use of high-cost surgical supplies must be thoroughly justified. Skull base surgeries are among the most technically complex performed in hospitals, with a high risk of complications. Among the materials commonly used in these interventions are hemostatic agents such as Surgiflo Thrombin, whose high cost raises concerns regarding routine use. Given this context, we aimed to evaluate the effectiveness of Surgiflo Thrombin in achieving intraoperative hemostasis during skull base surgeries. The primary objective of this study was to assess clinical outcomes associated with its use, particularly the prevention of hemorrhagic complications, to provide evidence supporting or questioning its justified use in high complexity procedures. This study was conducted without conflicts of interest and was solely driven by the need to optimize the use of surgical resources in our setting. Methods: We included all patients who underwent oncologic skull base surgery in which Surgiflo Thrombin was used as a hemostatic agent. Variables evaluated included tumor type, presence of complications (especially hemorrhagic events) and any adverse events potentially related to the use of the product. Results: Surgiflo Thrombin was used in 35 patients with brain tumors located at the skull base or in deep seated regions. Of these, 15 patients (44%) underwent endonasal endoscopic approaches, while 19 underwent transcranial surgery. Only one case of postoperative hemorrhage was recorded. The patient, who had a history of advanced breast cancer, developed postoperative thrombocytopenia associated with hematoma expansion, which necessitated surgical reintervention. Despite these measures, the patient unfortunately died. No adverse reactions directly associated with the product were identified. Notably, we observed an increased infection rate (11.4%) compared to our institutional average for brain tumor surgeries (