Nakayama T, Shimazaki K, Ono J, Ohsato K, Yamaura A
Department of Neurosurgery, Chiba University School of Medicine, Japan.
No Shinkei Geka. 1994 Nov;22(11):1081-4.
Reported here is a rare case of intracranial foreign body granuloma caused by fine cotton fibers originating from the cotton sheet, which was used in the previous operation. The patient was a 54-year-old woman who presented with headache and right hemiparesis. CT scan demonstrated a large enhanced tumor in the left temporal lobe. During the operation, the tumor bled easily and was hard to remove. The brain surface was covered with oxidized cellulose (Oxycell) after the tumor was subtotally removed. Cotton sheets (Surgical Patty) were also used during the operation. The microfibrillar collagen hemostat (Avitene) was not applied. The histological diagnosis was astrocytoma. Radio-chemotherapy was given. CT and MRI on the 40th day after the operation, showed a large tumor in the left temporal lobe, which led to suspicions of tumor recurrence. The second operation disclosed a mass which was harder in consistence than the previous one. The histological diagnosis was foreign body granuloma, which contained a lot of fine cotton fibers. Oxycell was not found in it. The cotton-sheet is well documented as a cause of granuloma in the literature, but it is seldom mentioned that the foreign body granuloma is caused by cotton fibers, scattered in the operative fields. This case report suggests the possibility of cotton-fiber granuloma and our simple experiment indicated that a lot of cotton fiber might be scattered in the operative fields, if dry cotton sheets are used. These results stress that washed cotton sheets should be applied to avoid the possibility of the development of cotton-fiber foreign body granuloma.
本文报道了一例罕见的颅内异物肉芽肿病例，其由先前手术中使用的棉床单上的细棉纤维引起。患者为一名54岁女性，表现为头痛和右侧偏瘫。CT扫描显示左颞叶有一个大的强化肿瘤。手术过程中，肿瘤容易出血且难以切除。肿瘤次全切除后，脑表面覆盖有氧化纤维素（Oxycell）。手术中也使用了棉床单（手术巾）。未应用微纤维胶原止血剂（Avitene）。组织学诊断为星形细胞瘤。给予了放化疗。术后第40天的CT和MRI显示左颞叶有一个大肿瘤，这引发了肿瘤复发的怀疑。第二次手术发现了一个质地比前一个更硬的肿块。组织学诊断为异物肉芽肿，其中含有大量细棉纤维。未在其中发现氧化纤维素。棉床单作为肉芽肿的病因在文献中有充分记载，但很少有人提及异物肉芽肿是由散落在手术区域的棉纤维引起的。本病例报告提示了棉纤维肉芽肿的可能性，我们的简单实验表明，如果使用干棉床单，手术区域可能会散落大量棉纤维。这些结果强调应使用洗涤过的棉床单以避免棉纤维异物肉芽肿形成的可能性。
