Loh Ryan T S, Matys Tomasz, Allinson Kieren S J, Santarius Thomas
1University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; and.
Departments of2Radiology.
J Neurosurg Case Lessons. 2022 Feb 21;3(8). doi: 10.3171/CASE21479.
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.
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.
The authors show that gossypibomas can occur following a relatively minor procedure and remain clinically and radiologically silent for much longer than previously reported.
术后遗留的可吸收止血剂偶尔会导致肉芽肿性占位性病变，即所谓的“棉球瘤”。作者报告了一例颅内棉球瘤病例，这种情况极为罕见，在影像学上通常与其他病变难以区分。
一名35岁女性出现全身强直阵挛性发作，随后出现左侧偏瘫。磁共振成像显示右侧额部钻孔下方有一个强化的分叶状病变，周围伴有血管源性水肿，有占位效应和中线移位。9年前，她因创伤性脑损伤接受了三通道螺栓植入以监测颅内压。植入过程中使用了外科用止血纱布控制出血。该病变与9年前三通道螺栓的位置相符，这引发了对棉球瘤的怀疑。然而，手术规模较小以及从手术到出现症状的时间间隔较长，使得该病例超出了文献报道的范围。病变被整块切除，18个月后无复发。组织学检查发现有异物。然而，由于其尺寸微小，无法确定其性质。
作者表明，棉球瘤可在相对较小的手术后发生，并且在临床和影像学上保持无症状的时间比先前报道的长得多。
