Granuloma caused by oxidized cellulose following craniotomy

Abstract

Three cases are reported in which large granulomas developed 13 to 21 months respectively after removal of intracranial meningiomas (2 cases) and after operation for an anterior communicating artery aneurysm. In each of the cases oxidized cellulose had been used and left in place for haemostasis. All of the granulomas acted as space-occupying lesions. They could be removed operatively with good result. All of them consisted of mononuclear phagocytic and multi-nuclear giant cells and contained remnants of oxidized cellulose. No comparable cases have been reported in the literature. Diagnosis, treatment and possible aetiological factors are discussed.

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

“…This practice may induce a rare granulomatous inflammatory reaction close to and onto the surgical site (6). This may lead to symptoms and/ or neuroradiological findings such as mass lesions virtually indistinguishable from recurrent tumor or postoperative intracranial abscesses at CT-MRI scans (7).…”

“…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.…”

Granulomatous inflammation of dura mater – a rare side effect after application of hemostatic and insulation materials in case of two-stage operation of huge meningioma

“…The literature contains examples of sterile formation of intracranial granuloma [1,4,9]. Undesirable effects in the form of granulomatous processes in the place where artificial insulating, sealant and hae mostatic materials or stitches were used are described in the literature [4,9,[12][13][14].…”

“…Undesirable effects in the form of granulomatous processes in the place where artificial insulating, sealant and hae mostatic materials or stitches were used are described in the literature [4,9,[12][13][14]. Cases of granulomas formation of various sizes and locations, causing clinical symptoms of a local mass effect or suggesting re-growth of the tumour were also published [11,[14][15][16].…”

“…hypersensitivity to the aforesaid proteins, one can observe local or generalized reactions of the organism. The literature describes inflammatory infiltrations of a foreign body type, formation of granulomas or pseudo-tumour regrowth as a rare reac tion to haemostatic materials used in surgery [4,9,11,14,16]. Quite often postoperative formation of intracranial granulomas, resulting in a mass effect (space occupying lesions), can mimic tumour recurrence [1,3,8,11,12,15,16].…”