Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Neuropathology Unit, Division of Pathology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy.
World Neurosurg. 2020 Oct;142:212-217. doi: 10.1016/j.wneu.2020.06.214. Epub 2020 Jul 4.
Gelfoam is a simple and effective hemostatic agent that is used to seal brain corticotomies or skull burr holes. Owing to its low cost, it is one of the most widely used tools in neurosurgical daily practice. However, migration of Gelfoam fragments can cause occlusion of endoscopic third ventriculostomy (ETV) or shunt, leading to hydrocephalus recurrence.
Two cases of Gelfoam migration causing recurrent hydrocephalus are presented: a 12-year-old girl who underwent surgery for posterior fossa tumor removal and ETV for associated hydrocephalus, where a portion of Gelfoam (used to seal the burr hole) migrated up to close the ETV, and a preterm 8-month-old boy who was treated by neuroendoscopic brain lavage and afterward by ventriculoperitoneal shunt for posthemorrhagic hydrocephalus, where all the Gelfoam used to close the corticotomy migrated into the lateral ventricle, thus reopening the corticotomy and releasing small fragments that ultimately obstructed the shunt. A new endoscopic procedure was required in both patients (the second patient also required a shunt revision).
Review of the pertinent literature discloses other complications of Gelfoam migration (e.g., mass effect, granulomatous reaction) as well as other causes of uncommon ETV/shunt obstruction. Nonetheless, Gelfoam will remain an indispensable tool for neurosurgeons. The present report emphasizes the importance of its correct use to avoid complications.
Gelfoam 是一种简单有效的止血剂，用于封闭脑皮质切开术或颅骨钻骨孔。由于其成本低，是神经外科日常实践中使用最广泛的工具之一。然而，Gelfoam 碎片的迁移可导致内镜第三脑室造瘘术（ETV）或分流管阻塞，从而导致脑积水复发。
报告了两例 Gelfoam 迁移导致复发性脑积水的病例：一名 12 岁女孩，因后颅窝肿瘤切除和 ETV 治疗相关脑积水而行手术，其中一部分 Gelfoam（用于封闭钻骨孔）迁移至 ETV 处导致其阻塞；一名 8 个月大的早产儿，因脑出血后行神经内镜脑灌洗和脑室-腹腔分流术治疗脑积水，所有用于封闭皮质切开术的 Gelfoam 均迁移至侧脑室，从而重新开放皮质切开术并释放小碎片，最终阻塞分流管。两名患者均需要进行新的内镜手术（第二例患者还需要进行分流管修正）。
对相关文献的回顾揭示了 Gelfoam 迁移的其他并发症（例如，占位效应、肉芽肿反应）以及 ETV/分流管阻塞的其他罕见原因。尽管如此，Gelfoam 仍将是神经外科医生不可或缺的工具。本报告强调了正确使用 Gelfoam 以避免并发症的重要性。
