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Su J, Liang S, Lin Q, Hu Z, Liao W, Zhu Y. Construction Industry-Associated Penetrating Craniocerebral Injuries. J Neurol Surg A Cent Eur Neurosurg 2023; 84:584-587. [PMID: 35144296 DOI: 10.1055/a-1768-3732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Various high-energy tasks in the construction industry can lead to craniocerebral injuries. Construction industry-associated penetrating craniocerebral injuries due to metal foreign bodies have unique characteristics. However, no norms exist for removing metal foreign bodies and preventing secondary trauma. This study aimed to explore the characteristics and treatment of construction industry-associated penetrating craniocerebral injuries due to metal foreign bodies. METHODS Data of patients who suffered from penetrating injuries due to metal foreign bodies and were treated in the Zhongshan People's Hospital from 2001 to 2021 were collected based on the causes of injuries to explore disease characteristics and therapeutic effects. RESULTS A total of six patients with penetrating craniocerebral injuries due to metal foreign bodies, who underwent surgeries, were included in the study. Five patients recovered well after the surgery, and one patient died. In four patients, intracranial infection complicated the course after surgery, and two patients had delayed intracranial hematoma. CONCLUSION Patients with construction industry-associated penetrating craniocerebral injuries due to metal foreign bodies are prone to coma and intracranial vascular injuries. Early surgical removal and prevention of intracranial infection are key to achieving good therapeutic effects.
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Affiliation(s)
- Jiahao Su
- Department of Neurosurgery, Zhongshan City People's Hospital, Zhongshan, Guangdong, People's Republic of China
| | - Sitao Liang
- Department of Neurosurgery, Zhongshan City People's Hospital, Zhongshan, Guangdong, People's Republic of China
| | - Qichang Lin
- Department of Neurosurgery, Zhongshan City People's Hospital, Zhongshan, Guangdong, People's Republic of China
| | - Zihui Hu
- Department of Neurosurgery, Zhongshan City People's Hospital, Zhongshan, Guangdong, People's Republic of China
| | - Wei Liao
- Department of Neurosurgery, Zhongshan City People's Hospital, Zhongshan, Guangdong, People's Republic of China
| | - Yonghua Zhu
- Department of Neurosurgery, Zhongshan City People's Hospital, Zhongshan, Guangdong, People's Republic of China
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Loh RTS, Matys T, Allinson KSJ, Santarius T. Intracranial gossypiboma 9 years after intracranial pressure bolt insertion: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21479. [PMID: 36130548 PMCID: PMC9379616 DOI: 10.3171/case21479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/04/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Resorbable hemostatic agents left behind postoperatively occasionally result in granulomatous space-occupying lesions known as “gossypibomas.” The authors report a case of an intracranial gossypiboma, which is exceedingly rare and frequently radiologically indistinguishable from other lesions. OBSERVATIONS A 35-year-old woman presented with a generalized tonic-clonic seizure and subsequent left-sided hemiparesis. Magnetic resonance imaging showed an enhancing lobulated lesion subjacent to a right frontal burr hole, surrounded by vasogenic edema with mass effect and midline shift. Nine years earlier, she had had a triple bolt inserted to monitor intracranial pressure after sustaining a traumatic brain injury. Surgicel was used to control bleeding during insertion. Colocation of the lesion with the position of triple bolt 9 years earlier raised suspicion for gossypiboma. However, the minor nature of the surgery and the length of time since surgery to presentation placed this case well outside the range of cases reported in the literature. The lesion was resected en bloc with no recurrence 18 months later. Histological examination revealed the presence of foreign material. However, given its minute size, confirming its nature was not possible. Lessons The authors show that gossypibomas can occur following a relatively minor procedure and remain clinically and radiologically silent for much longer than previously reported.
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Affiliation(s)
- Ryan T. S. Loh
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; and
| | | | | | - Thomas Santarius
- Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, United Kingdom
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De Jesus O, Fernández-de Thomas RJ. Bone Fragment Granuloma Mimicking a Brain Tumor Following Placement of an Intracranial Pressure Monitoring System. Cureus 2021; 13:e15394. [PMID: 34249544 PMCID: PMC8253461 DOI: 10.7759/cureus.15394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 11/07/2022] Open
Abstract
The placement of intracranial pressure (ICP) monitoring system requires drilling an orifice in the skull. Bone fragments can accidentally be inserted into the brain parenchyma while introducing the ICP monitoring system during the procedure. An intracranial granuloma can be subsequently formed if a non-specific reaction is induced and maintained by the inserted bone fragment in the brain parenchyma. These intracranial granulomas may eventually be confused with brain masses on follow-up imaging studies. We present the case of a 65-year-old male who underwent cranial surgery secondary to a severe traumatic brain injury (TBI). An intracranial bolt was initially placed contralaterally to measure the ICP. Eleven years later, a granuloma from a retained bone fragment secondary to the intracranial bolt placement was suspected. The clinical course, radiological investigations, and differential diagnosis are presented.
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Affiliation(s)
- Orlando De Jesus
- Neurosurgery, University of Puerto Rico, Medical Sciences Campus, San Juan, PRI
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Franceschini G. Use of Oxidized Regenerated Cellulose as a Hemostatic Agent in Neurosurgery: Appraisals and Recommendations to Prevent Postoperative Complications and Facilitate Follow-Up. Surg Technol Int 2021; 38:481-485. [PMID: 33592670 DOI: 10.52198/21.sti.38.ns1397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Neurosurgical hemostasis can be performed with bipolar coagulation and with the support of several dedicated biomaterials including oxidized regenerated cellulose (ORC; e.g., Surgicel®, Johnson & Johnson, New Brunswick, NJ, USA). Oxidized regenerated cellulose is a sterile absorbable fibrous biomaterial that has become a major local hemostatic agent thanks to its ease of use, favorable biocompatibility and bioabsorption characteristics. However, some postoperative issues associated with its use, such as allergic reaction, seroma, foreign-body reaction with compressive neuropathies and misdiagnosis during follow-up, have been reported. These complications could compromise clinical outcomes with a negative impact on patient quality of life and sometimes require risky major surgical procedures. An understanding of the specific properties of ORC combined with adequate surgical expertise and compliance with some basic rules are needed to optimize clinical outcomes and minimize postoperative issues.
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Affiliation(s)
- Gianluca Franceschini
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS; Università Cattolica del Sacro Cuore Multidisciplinary Breast Unit, Department of Woman and Child Health and Public Health. Largo Agostino Gemelli, Rome, Italy
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MRI findings for diagnosis of postoperative foreign body granulomas versus recurrent tumours in patients of brain tumour surgery. Clin Radiol 2021; 76:316.e19-316.e28. [PMID: 33551151 DOI: 10.1016/j.crad.2020.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/24/2020] [Indexed: 11/21/2022]
Abstract
AIM To evaluate the postoperative magnetic resonance imaging (MRI) findings of intracranial foreign body granulomas (FBGs) and true recurrent tumours (RTs) and thus lead to a basis for management decision-making. MATERIALS AND METHODS Twenty-two patients with previous brain tumour surgery were diagnosed clinically with RT and underwent surgery. Re-operative pathology revealed FBG in eight patients and RT in 14 patients. MRI findings before the initial operation were compared to those before the re-operation. RESULTS Features of FBGs versus RTs on MRI were as follows: (1) mean lesion size: 1.3 ± 0.7 (0.5-2.6) versus 3.2 ± 1.7 (1.1-6.3) cm (p=0.001, odds ratio [OR] = 4.18); (2) hypointensity on T2-weighted imaging (WI): 6/8 (75%) versus 0/14 (0%; p<0.001, OR=75.4); (3) non-restricted diffusion on diffusion-WI (DWI): 6/8 (75%) versus 2/14 (14.3%; p=0.008, OR=18); and (4) "ring and bubble" appearance on contrast-enhanced T1WI: 7/8 (87.5%) versus 2/14 (14.3%; p=0.001, OR=42). In comparison with their original tumours, the FBGs in the FBG group showed significantly lower T2 signal intensity, lower signal on DWI, and more cases of non-restricted diffusion on DWI (p=0.04, 0.04, 0.04, respectively). CONCLUSION On brain MRI, FBGs can be differentiated from RTs by their relatively smaller size, hypointensity on T2WI, lack of restricted diffusion on DWI, and "ring and bubble" appearance on contrast-enhanced T1WI. Comparing the MRI findings of the focal lesion in the tumour bed with those of the original tumour is suggested to enhance diagnostic confidence.
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An anti-inflammatory gelatin hemostatic agent with biodegradable polyurethane nanoparticles for vulnerable brain tissue. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 121:111799. [PMID: 33579446 DOI: 10.1016/j.msec.2020.111799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/15/2020] [Accepted: 12/05/2020] [Indexed: 11/23/2022]
Abstract
Hemostasis plays a fundamental and critical role in all surgical procedures. However, the currently used topical hemostatic agents may at times undesirably induce inflammation, infection, and foreign body reaction and hamper the healing process. This may be serious in the central nervous system (CNS), especially for some neurosurgical diseases which have ongoing inflammation causing secondary brain injury. This study was aimed to develop a hemostatic agent with anti-inflammatory property by incorporating carboxyl-functionalized biodegradable polyurethane nanoparticles (PU NPs) and to evaluate its functionality using a rat neurosurgical model. PU NPs are specially-designed anti-inflammatory nanoparticles and absorbed by a commercially available hemostatic gelatin powder (Spongostan™). Then, the gelatin was implanted to the injured rat cortex and released anti-inflammatory PU NPs. The time to hemostasis, the cerebral edema formation, and the brain's immune responses were examined. The outcomes showed that PU NP-contained gelatin attenuated the brain edema, suppressed the gene expression levels of pro-inflammatory M1 biomarkers (e.g., IL-1β level to be about 25%), elevated the gene expression levels of anti-inflammatory M2 biomarkers (e.g., IL-10 level to be about 220%), and reduced the activation of inflammatory cells in the implanted site, compared with the conventional gelatin. Moreover, PU NP-contained gelatin increased the gene expression level of neurotrophic factor BDNF by nearly 3-folds. We concluded that the PU NP-contained hemostatic agents are anti-inflammatory with neuroprotective potential in vivo. This new hemostatic agent will be useful for surgery involving vulnerable tissue or organ (e.g., CNS) and also for diseases such as stroke, traumatic brain injury, and neurodegenerative diseases.
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D'Amico A, Perillo T, Ugga L, Cuocolo R, Brunetti A. Intruding implements: a pictorial review of retained surgical foreign objects in neuroradiology. Insights Imaging 2019; 10:124. [PMID: 31853666 PMCID: PMC6920316 DOI: 10.1186/s13244-019-0817-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 11/08/2019] [Indexed: 02/04/2023] Open
Abstract
Intra-cranial and spinal foreign body reactions represent potential complications of medical procedures. Their diagnosis may be challenging as they frequently show an insidious clinical presentation and can mimic other life-threatening conditions. Their pathophysiological mechanism is represented by a local inflammatory response due to retained or migrated surgical elements. Cranial interventions may be responsible for the presence of retained foreign objects represented by surgical materials (such as sponges, bone wax, and Teflon). Spinal diagnostic and therapeutic procedures, including myelography, chordotomy, vertebroplasty, and device implantation, are another potential source of foreign bodies. These reactions can also follow material migration or embolization, for example in the case of Lipiodol, Teflon, and cement vertebroplasty. Imaging exams, especially CT and MRI, have a central role in the differential diagnosis of these conditions together with patient history. Neuroradiological findings are dependent on the type of material that has been left in or migrated from the surgical area. Knowledge of these entities is relevant for clinical practice as the correct identification of foreign bodies and related inflammatory reactions, material embolisms, or migrations can be difficult. This pictorial review reports neuroradiological semeiotics and differential diagnosis of foreign body-related imaging abnormalities in the brain and spine.
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Affiliation(s)
- Alessandra D'Amico
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Teresa Perillo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Renato Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
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Wang K, Li S, Xiang W, Ming Y, Peng T, Wang H, Chen L, Zhou J. Cerebral Granuloma Mimicking Malignant Neoplasm in Patient with Seizures 21 Years After Head Trauma. World Neurosurg 2019; 127:629-632.e1. [PMID: 30794983 DOI: 10.1016/j.wneu.2019.01.286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 01/28/2019] [Accepted: 01/30/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic posttraumatic cerebral granuloma is a rare, delayed complication of traumatic brain injury. Because of its late onset of symptoms and atypical appearance, the correct diagnosis of this rare lesion is difficult. CASE DESCRIPTION A 49-year-old man presented with seizures, which occurred 21 years after open right forehead trauma. Imaging techniques, such as magnetic resonance imaging and magnetic resonance spectroscopy, which indicated a malignant neoplasm, revealed a mass lesion on the right frontal lobe, invading the dura and partial frontal bone. The patient underwent total removal of the lesion and titanium mesh cranioplasty, simultaneously, due to invasion of the mass lesion into the skull. However, the postoperative histopathologic diagnosis was chronic inflammatory granuloma. At 1-year follow-up, he did not have any discomfort and epilepsy did not recur. CONCLUSIONS Chronic cerebral granuloma should be considered in the differential diagnosis of a novel or recurrent mass detected in patients with a history of traumatic brain injury or prior surgery. Moreover, the retained foreign bodies in the superficial or nonfunctional area of the brain should be thoroughly examined and removed at the time of injury, particularly in open brain trauma.
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Affiliation(s)
- Ke Wang
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P. R. China
| | - Shenjie Li
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P. R. China
| | - Wei Xiang
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P. R. China
| | - Yang Ming
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P. R. China
| | - Tao Peng
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P. R. China
| | - Haorun Wang
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P. R. China
| | - Ligang Chen
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P. R. China.
| | - Jie Zhou
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P. R. China
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Intracranial foreign material granulomas after cranial surgery. Acta Neurochir (Wien) 2018; 160:2069-2075. [PMID: 30187219 DOI: 10.1007/s00701-018-3663-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Various synthetic materials are used in neurosurgery and left in place intentionally during surgery for several purposes such as hemostasis, dural closure, or cranioplasty. Although leaving such substances in surgical sites is considered safe, in general, foreign body granuloma may occur months or years after intracranial surgery. Thus, far relatively little is known about treatment and outcome of such lesions. METHODS A systematic review of 3466 histopathological examinations after cranial surgeries achieved over a 13-year period was performed. After excluding patients with Teflon granulomas or infection, a total of 12 patients with foreign body granulomas induced by synthetic material used in a prior surgery were identified. Patient records, imaging studies, and histopathological data were analyzed. Furthermore, postoperative outcome was assessed. RESULTS Mean age at the second surgery was 51 years (range, 11-68 years). The median time between the primary and the secondary surgery was 13 months (range, 1-545 months). Eight patients (75%) presented with signs and symptoms related to the foreign body granulomas. Total resection of the foreign body granulomas was performed in all patients. The granulomas were induced by oxidized cellulose polymer (n = 6), suture material (n = 3), Gelfoam (n = 1), methylmethacrylate (n = 1), and bone wax (n = 1). The mean postoperative follow-up time was 54 months (range 1-137 months). There was symptomatic improvement in all instances. Imaging studies did not demonstrate any recurrence. CONCLUSION Despite its rarity, foreign body granuloma should be taken into consideration in the differential diagnosis of intracranial mass lesions especially in cases of suspected tumor recurrence after prior surgery. The pathogenesis of foreign body granuloma still needs further clarification. Our study demonstrates that they have good prognosis after surgical removal.
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Staglianò S, D'Arco F, Tan AP, Jeelani O, Morana G, Mankad K. Haemostatic material (Surgicel ®) mimicking residual tumour: magnetic resonance imaging findings in operated pediatric neuro-oncology cases. Quant Imaging Med Surg 2018; 8:971-978. [PMID: 30505725 DOI: 10.21037/qims.2018.09.04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Serena Staglianò
- Polo scienze delle immagini, di laboratorio ed infettivologiche, Area diagnostica per immagini, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1-00168, Rome, Italy
| | - Felice D'Arco
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ai Peng Tan
- Department of Radiology, National University Health System, Singapore
| | - Owase Jeelani
- Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Giovanni Morana
- Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Akhaddar A, Turgut AT, Turgut M. Foreign Body Granuloma After Cranial Surgery: A Systematic Review of Reported Cases. World Neurosurg 2018; 120:457-475. [PMID: 30267951 DOI: 10.1016/j.wneu.2018.09.143] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/16/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND In cranial surgery, different foreign body (FB) materials are used and may be left intentionally or unintentionally in the surgical field after closure, inducing a foreign body granuloma (FBG). This is a rare complication in neurosurgery, but it may be a diagnostic dilemma, with sometimes medicolegal implications. METHODS We performed a systematic review of the English literature between 1965 and 2018 and found a total of 77 articles concerning 100 cases of FBG caused by retained material located within the cranium or surrounding soft tissues. RESULTS There were 60 females and 40 males, with ages ranging from 1 to 77 years. Most initial diagnoses were cranial/intracranial tumors, trigeminal neuralgia, hemifacial spasm, intracranial aneurysm, hydrocephalus, head injury, infectious disease, and nontraumatic intracerebral hematoma. The interval from the causative surgical operation to presentation of the FBG ranged from 2 weeks to 20 years. Various radiologic modalities were used and histologic study confirmed the presence of FBG in all patients. Intentional FB was used and left in 77 patients, and unintentional FB was found postoperatively in 23 patients. Associated infection was found in 13 patients. Complete recovery was seen in 47.6% of patients with sufficient data. CONCLUSIONS Despite being unusual, a retained FBG should be considered in the differential diagnosis of any patient after cranial surgery. A history of surgery, clinical symptoms, physical examination findings, laboratory results, and the use of appropriate neuroimaging explorations may provide a correct preoperative diagnosis. In addition, unintentionally retained FBs are preventable errors in the operating room.
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Affiliation(s)
- Ali Akhaddar
- Department of Neurosurgery, Avicenne Military Hospital of Marrakech, Mohammed V University in Rabat, Rabat, Morocco.
| | - Ahmet T Turgut
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Mehmet Turgut
- Department of Neurosurgery, Adnan Menderes University School of Medicine, Aydın, Turkey
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Kikuchi Y, Hiwatashi A, Togao O, Yamashita K, Momosaka D, Honda H. Cerebral syphilitic gumma mimicking glioma: Utility of CT perfusion. Diagn Interv Imaging 2018; 99:755-757. [PMID: 29910168 DOI: 10.1016/j.diii.2018.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Y Kikuchi
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, 812-8582 Fukuoka, Higashi-ku, Japan
| | - A Hiwatashi
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, 812-8582 Fukuoka, Higashi-ku, Japan.
| | - O Togao
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, 812-8582 Fukuoka, Higashi-ku, Japan
| | - K Yamashita
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, 812-8582 Fukuoka, Higashi-ku, Japan
| | - D Momosaka
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, 812-8582 Fukuoka, Higashi-ku, Japan
| | - H Honda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, 812-8582 Fukuoka, Higashi-ku, Japan
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Kumar R, Nadarajah J, Kumar A, Gamanagatti S. Misery of neurosurgeon: Gauzoma causing foreign body granuloma-role of radiologist. Asian J Neurosurg 2016; 11:74-5. [PMID: 26889295 PMCID: PMC4732258 DOI: 10.4103/1793-5482.165797] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Materials used in neurosurgery to achieve hemostasis may be of resorbable or nonresorbable substance and may cause foreign body granuloma if left at the operative site. Foreign body granuloma depending on clinical history may be indistinguishable from an abscess, resolving infarction, and hematoma. Here we present two cases, who had decompressive craniectomy following road traffic accident. Follow-up computerized tomography (CT) scan revealed hyperdense lobulated lesion with peripheral rim enhancement. On magnetic resonance imaging (MRI), lesions were predominantly hypointense on T1-weighted images, and hyperintense on T2-weighted images and showed a lack of restricted diffusion. In view of recent craniectomy and imaging findings diagnosis of foreign body granuloma was made. Both patients underwent surgery, intraoperatively gauze pieces were retrieved from lesions which confirmed preoperative diagnosis. The combination of CT and MRI can diagnose foreign body granuloma, especially in trauma settings. Thus, we can help the surgeon by providing the probable diagnosis for proper management.
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Affiliation(s)
- Ravi Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Jeyaseelan Nadarajah
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Atin Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Shivanand Gamanagatti
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
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Khachatryan VA, Kim AV, Samochernykh KA, Sidorin VS, Sokolova TV, Don OA, Ivanov VP. [Granulomatous inflammation in the bed of resected cerebral cavernoma in a child, caused by a hemostatic agent]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2015; 79:84-94. [PMID: 26529626 DOI: 10.17116/neiro201579484-94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The study presents a clinical observation of foreign body granuloma, which is rare productive inflammation, developed on treatment with a hemostatic material upon removal of cerebral cavernoma. MATERIAL AND METHODS A 4-year-old boy operated on for left parietal lobe cavernoma was diagnosed with a mass lesion during a follow-up MRI examination 4 months after surgery. The patient was re-operated in connection with suspected abscess formation. The pathological tissue was subjected to the histological and immunohistochemical examination. RESULTS Inflammation was accompanied by the formation of foreign body granulomas, and, in some areas, had immune nature with signs of focal destructive vasculitis, delayed maturation of the granulation tissue, and disturbance of the current organization and encapsulation processes. It is worth noting that granulomatous inflammation around a hemostatic material in the brain has no specific features during introscopy and mimics an abscess or tumor recurrence. CONCLUSION The use of hemostatic materials upon resection of cerebral cavernous malformations may cause formation of granuloma mimicking disease relapse or abscess in the long term period. To prevent granulomatous inflammation, removal of a hemostatic material, if possible, from the surgical field is recommended when reliable hemostasis is achieved.
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Affiliation(s)
- V A Khachatryan
- Polenov Russian Research Neurosurgical Institute, St. Petersburg, Russia
| | - A V Kim
- Polenov Russian Research Neurosurgical Institute, St. Petersburg, Russia
| | - K A Samochernykh
- Polenov Russian Research Neurosurgical Institute, St. Petersburg, Russia
| | - V S Sidorin
- Polenov Russian Research Neurosurgical Institute, St. Petersburg, Russia
| | - T V Sokolova
- Polenov Russian Research Neurosurgical Institute, St. Petersburg, Russia
| | - O A Don
- Polenov Russian Research Neurosurgical Institute, St. Petersburg, Russia
| | - V P Ivanov
- Polenov Russian Research Neurosurgical Institute, St. Petersburg, Russia
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16
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Cruz JP, Marotta T, O'Kelly C, Holtmannspötter M, Saliou G, Willinsky R, Krings T, Agid R. Enhancing brain lesions after endovascular treatment of aneurysms. AJNR Am J Neuroradiol 2014; 35:1954-8. [PMID: 24874528 DOI: 10.3174/ajnr.a3976] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Complications of endovascular therapy of aneurysms mainly include aneurysm rupture and thromboembolic events. The widespread use of MR imaging for follow-up of these patients revealed various nonvascular complications such as aseptic meningitis, hydrocephalus, and perianeurysmal brain edema. We present 7 patients from 5 different institutions that developed MR imaging-enhancing brain lesions after endovascular therapy of aneurysms, detected after a median time of 63 days. The number of lesions ranged from 4-46 (median of 10.5), sized 2-20 mm, and were mostly in the same vascular territory used for access. Three patients presented with symptoms attributable to these lesions. After a median follow-up of 21.5 months, the number of lesions increased in 2, was stable in 1, decreased in 3, and disappeared in 1. The imaging and clinical characteristics suggested a foreign body reaction. We could find no correlation to a specific device, but a possible source may be the generic hydrophilic coating.
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Affiliation(s)
- J P Cruz
- From the Radiology Department (J.P.C.), Hospital Clínico de la Pontificia Universidad Católica de Chile, Santiago, Chile
| | - T Marotta
- Divisions of Neuroradiology (T.M.), St. Michael's Hospital, Toronto, Ontario, Canada
| | - C O'Kelly
- Department of Surgery (C.O.), University of Edmonton, Edmonton, Alberta, Canada
| | - M Holtmannspötter
- Division of Interventional Neuroradiology (M.H.), Københavns Universitet, Copenhagen, Denmark
| | - G Saliou
- Service de Neuroradiologié (G.S.), Hôpital de Bicêtre, Kremlin Bicêtre, France
| | - R Willinsky
- Toronto Western Hospital (R.W., T.K., R.A.), Toronto, Ontario, Canada
| | - T Krings
- Toronto Western Hospital (R.W., T.K., R.A.), Toronto, Ontario, Canada
| | - R Agid
- Toronto Western Hospital (R.W., T.K., R.A.), Toronto, Ontario, Canada.
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