止血法

Hemostasis

Point

・小脳橋角部腫瘍の摘出術では，深部へ出血の垂れ込みのない術野を形成することが安全性を高める．

・脳神経が近接しているため，その近傍ではバイポーラ焼灼を行わない．

・さまざまな止血材の利用法を理解し習熟することも重要である．

＊本論文中、［Video］マークのある図につきましては、関連する動画を見ることができます（公開期間：2028年8月まで）。

　Hemostasis is a critical skill in cerebellopontine angle (CPA) tumor surgery given its deep anatomical location, narrow surgical corridor, and proximity to vital neurovascular structures. Inadequate bleeding control can obscure the operative field, increase the risk of cranial nerve injury, and lead to life-threatening complications, such as brainstem infarction or cerebellar swelling. This article outlines the key principles of hemostasis at each step of CPA tumor resection, from the preoperative setting and craniotomy to tumor debulking and dissection. Based on our surgical experience, we present detailed technical strategies for achieving safe and effective hemostasis during meningioma, vestibular schwannoma, and hemangioblastoma resection. Practical tips include the management of emissary veins; the preservation of draining veins, such as the petrosal vein; and staged tumor resection adapted to the vascular supply. Videos of representative cases are included to demonstrate hemostatic techniques in real surgical settings. Through emphasizing complete bleeding control at each stage before proceeding to the next, this article aims to provide practical guidance for neurosurgeons in training and promote safer skull base tumor surgery.