Recombinant activated factor VII in the treatment of near-fatal bleeding during pediatric brain tumor surgery. Report of two cases and review of the literature.

Recombinant activated factor VII (rFVIIa) was successfully used in two pediatric cases to control microvascular bleeding during brain tumor surgery. The agent demonstrated a marked effect on the intraoperative blood coagulation after failure of conventional therapy with fresh-frozen plasma, platelet concentrates, and inhibition of the fibrinolytic system. Remarkably, rFVIIa was effective in the present cases in which assessment of hemostasis yielded normal results. The use of rFVIIa should be considered in otherwise untreatable microvascular bleeding in pediatric neurosurgery.