More than just a urinary catheter: achieving hemostasis using Foley catheter in deep cerebral cavities—technical nuances

Achieving hemostasis during neurosurgical procedures within deep seated tumors is of paramount importance. Chemical methods like using ORC and gel foam are preferred to bipolar cautery as bipolar cautery causes thermal injury to the normal eloquent surrounding white matter fibers, thereby causing significant morbidities. In addition to the chemical methods, we advocate a new relatively simple mechanical method by using small size Foley catheter inflated with saline can achieve hemostasis in case of deep locating brain tumor surgery with diffuse oozing from the tumor bed and surrounding white matter tissues are of concern. The balloon tamponade effect of the inflated Foley catheter helps in achieving complete hemostasis without damaging the surrounding normal white matter parenchyma. A 52-years-old female admitted with history of progressive drowsiness and altered sensorium. Brain MRI was done showing large right-sided trigonal meningioma. Right parieto-occipital craniotomy was done, through the superior parietal lobe, corticotomy was done, and tumor was reached. Gentle retraction was done using curved blades in between the tumor and normal brain parenchyma. During surgery, following tumor removal, there was a diffuse oozing from tumor bed and the surrounding stretched white matter fibers. Hemostasis was attempted with chemical methods like ORC and gel foam. We avoided bipolar cautery to prevent thermal injury to the normal stretched eloquent white matter, as bleeding was not settled over the period of 45 min using chemical methods. Then, we placed a 10 F size Foley catheter in the tumor cavity and inflated with 6 ml of saline over the period of 10 min. Prior to Foley placement, we coated ORC over the tumor bed and the surrounding white matter. This achieved hemostasis to a significant extent and the same was repeated for another 10 min, and finally, complete hemostasis was achieved. Postoperative period went uneventful. Patient was discharged with good neurological recovery. Inflatable Foley catheter balloon is a simple, cost-effective technique for achieving hemostasis in deep white matter tumors in addition to the routinely available hemostatic techniques.