Gelfoam Granuloma Mimicking Brain Abscess Following Decompressive Craniotomy

Abstract

The use of adjuvants in brain surgery has increased. Artificial adjuncts are being used in neurosurgery frequently. These foreign materials may result in a foreign body reaction inside the normal brain tissue surrounding the areas of pathology. This material may mimic an abscess or tumor in their presentation and masquerade the magnetic resonance (MR) or computed tomography (CT) image as recurrence, abscess, or granuloma. We present a case of a 42-year-old woman with a history of hypertensive basal ganglia bleeding who was operated on in an emergency. Decompressive craniectomy and clot evacuation were carried out. A thin layer of Gelfoam was applied in the operated area. After 4 weeks, she was planned for cranioplasty where an oval soft to firm yellowish lesion was found at the site of the previous cavity of the evacuated clot, which was sent for biopsy and it was confirmed as a Gelfoam granuloma. Meticulous use of hemostatic agents in the form of small surgical or thin waferlike gelatin sponges should be used intraoperatively. Large-size Gelfoam and artificial agents can lead to foreign body–like granulation tissue formation in normal brain tissue and several complications like hydrocephalous, meningitis, and seizures. Peculiarities in this case include the following: Gelfoam granuloma is a very rare complication following cranial surgery, it was mimicking like an abscess, and the size of Gelfoam used intraoperatively should be a thin wafer coating the raw surface or in the cavity.

Keywords

• Gelfoam granuloma
• decompressive craniectomy
• brain abscess