In November 2023, the Department of Neurosurgery at Kitano Hospital, Institute of Medical Sciences, published a paper on the correct method of using hemostatic agents on the skull, alerting neurosurgeons around the world.

There are various methods to stop bleeding during surgery. For over 50 years,beeswax［beeswax］Similar to (bone wax［Kotsuro］It is a well-established worldwide practice to stop bleeding by applying bone wax to the bleeding area. In the field of neurosurgery, bone wax is also used to treat bleeding from the skull.

When bone wax is used on the skull, there is a rare chance that the bone wax may get mixed into the veins on the back of the bone via the veins that penetrate the skull (straying). In the case of the skull, the veins on the back of the bone are connected to the veins of the brain, so caution is required, but the issue of bone wax getting mixed up has not been investigated in detail until now.

To investigate the presence of aberrant bone wax, we retrospectively reviewed CT and MRI images of 241 cases in which craniotomy was performed at the same site (checking past medical information, etc.), and found aberrant bone wax in 54 cases. In most of these cases, the amount was very small, on the order of a few millimeters, and did not pose any clinical problems.

When we investigated the causes of the misplacement, we found that veins that penetrate the skull, those with a large original diameter, and those that penetrate the skull but become shorter during craniotomy, were significantly associated with the misplacement of bone wax.

Based on these results, we checked the diameter and length of the veins penetrating the skull before surgery, and in cases where it was suggested that bone wax might have gotten lost, we investigated a method of hemostasis that does not use bone wax, which we are currently applying in clinical practice.

We have now compiled these reports and published a paper describing a method of hemostasis that does not use bone wax for veins that penetrate the skull, where there is a risk of bone wax getting lost, to alert neurosurgeons around the world.

The Department of Neurosurgery will continue to conduct research and consider measures to improve surgical safety.

• Risk of Bone Wax Migration During Retrosigmoid Craniotomy for Microvascular Decompression: Case-Control Study

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