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CC BY 4.0 · Indian Journal of Neurosurgery
DOI: 10.1055/s-0044-1788813
Brief Report

Gelfoam Granuloma Mimicking Brain Abscess Following Decompressive Craniotomy

Souvagya Panigrahi
1   Department of Neurosurgery, IMS & SUM Hospital, SOA University, Bhubaneswar, Odisha, India
,
Abhijit Acharya 
1   Department of Neurosurgery, IMS & SUM Hospital, SOA University, Bhubaneswar, Odisha, India
,
Surya Pratap Singh Tomar
1   Department of Neurosurgery, IMS & SUM Hospital, SOA University, Bhubaneswar, Odisha, India
,
A. K. Mahapatra
1   Department of Neurosurgery, IMS & SUM Hospital, SOA University, Bhubaneswar, Odisha, India
,
Rama Chandra Deo 
1   Department of Neurosurgery, IMS & SUM Hospital, SOA University, Bhubaneswar, Odisha, India
,
Soubhagya Ranjan Tripathy
1   Department of Neurosurgery, IMS & SUM Hospital, SOA University, Bhubaneswar, Odisha, India
,
Satya Bhusan Senapati
1   Department of Neurosurgery, IMS & SUM Hospital, SOA University, Bhubaneswar, Odisha, India
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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


Publication History

Article published online:
16 September 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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