Foreign body reaction to hemostatic materials mimicking recurrent brain tumor

Abstract

Chemical agents routinely used in neurosurgery to achieve intraoperative hemostasis can cause a foreign body reaction, which appears on magnetic resonance (MR) images to be indistinguishable from recurrent tumor. Clinical and/or imaging evidence of progression of disease early after surgical resection or during aggressive treatment may actually be distinct features of granuloma in these circumstances. A series of three cases was retrospectively analyzed for clinical, imaging, surgical, and pathological findings, and the consequences they held for further disease management. All patients were boys (3, 3, and 6 years of age, respectively) and all harbored primitive neuroectodermal tumors. Two tumors were located in the posterior fossa and one was located in the right parietal lobe. Two boys exhibited clinical symptoms, which were unexpected under the circumstances and prompted new imaging studies. One patient was asymptomatic and imaging was performed at planned routine time intervals. The MR images revealed circumscribed, streaky enhancement in the resection cavity that was suggestive of recurrent disease. This occurred 2 to 7 months after the first surgery. At repeated surgery, the resected material had the macroscopic appearance of gelatin sponge in one case and firm scar tissue in the other cases. Histological analysis revealed foreign body granulomas in the resected material, with Gelfoam or Surgicel as the underlying cause. No recurrent tumor was found and the second surgery resulted in imaging-confirmed complete resection in all three patients. Because recurrent disease was absent, the patients continued to participate in their original treatment protocols. All patients remain free from disease 34, 32, and 19 months after the first operation, respectively. During or after treatment for a central nervous system neoplasm, if unexpected clinical or imaging evidence of recurrence is found, a second-look operation may be necessary to determine the true nature of the findings. If the resection yields recurrent tumor, additional appropriate oncological treatment is warranted, but if a foreign body reaction is found, potentially harmful therapy can be withheld or postponed.

Pontine compression caused by “surgiceloma” after trigeminal decompression: case report and literature review

“…The presence of giant cells has been reported within 1 week, disappearing with the product 1-2 months after surgery [10] . Com after spina which man was found reported in compressio [7,8,10,11] . is have been f nervous str …”

Retained Surgical Sponges after Craniotomies: Imaging Appearances and Complications

“…An exception to the nonresorbable agents is muslin, which is a cotton fabric occasionally used to reinforce aneurysmal walls during surgical repair of intracranial aneurysms. Although there are case reports describing an excessive inflammatory response to resorbable hemostatic agents 5 and muslin, 6 this is more commonly observed with the nonresorbable materials. Nonresorbable hemostatic agents commonly used in neurosurgical procedures are synthetic rayon fibers fashioned into strips or pledgets (cottonoids and kites) containing filaments impregnated with radiopaque barium sulfate that allow visualization on plain radiographs or on CT scans.…”

Foreign Body Reaction Mimicking Intracranial Abscess following the Use of Oxidized Regenerated Cellulose (SurgicelTM): Case Report and Literature Review

“…Among all, we considered 2 three-year-old children (16.66%). Patients included in this review underwent surgery first time for intracranial meningioma removal in 7 cases (58.33%) (2,5,6,9), intracranial aneurysm clipping in 1 case (8.33%) (6), inferior vermis medulloblastoma in 1 case (8.33%) (7), AVM+parietal PNET in 1 case (8.33%) (7), gliosarcoma in 1 case (8.33%) and tanycityc ependymoma in the other 1 case (8.33%) (8).…”

“…The occurrence of granulomatous inflammatory foreign body reaction due to the use of oxidized regenerated cellulose (Surgicel TM ; Ethicon, Inc., Somerville, NJ) is extremely rare: only few cases were published (2,(5)(6)(7)(8)(9). We report a case of 54 year-old man previously operated for intracranial meningioma who underwent surgery again for a granulomatous foreign body reaction mimicking postoperative brain abscess.…”