Teflon Granuloma of the Skull Base: A Complication of Endonasal Brain Surgery

ABSTRACT

Teflon granuloma is an inflammatory giant-cell foreign-body reaction to polytetrafluoroethylene fibers or injection. Tissue augmentation with Teflon has dramatically declined over the past two decades because of its implication in granuloma formation. Nevertheless, Teflon felt is still commonly used in neurosurgical dissection and microvascular decompression. We report a patient with a Teflon granuloma of the skull base discovered 1.5 years after endonasal resection of an olfactory groove meningioma. The case highlights the clinical and radiographic diagnosis as well as the management of this unusual finding.

Teflon granuloma - endonasal neurosurgery - meningioma - skull base

REFERENCES

• 1 Varvares M A, Montgomery W W, Hillman R E. Teflon granuloma of the larynx: etiology, pathophysiology, and management.  Ann Otol Rhinol Laryngol. 1995;  104 511-515
• 2 Harrigal C, Branstetter B F, Snyderman C H et al.. Teflon granuloma in the nasopharynx: a potentially false-positive PET/CT finding.  AJNR Am J Neuroradiol. 2005;  26 417-420
• 3 Hewitt R J, Singh A, Wareing M J. Teflon-induced granuloma: a source of false positive positron emission tomography and computerized tomography interpretation.  J Laryngol Otol. 2004;  118 822-824
• 4 Yeretsian R A, Blodgett T M, Branstetter B F et al.. Teflon-induced granuloma: a false-positive finding with PET resolved with combined PET and CT.  AJNR Am J Neuroradiol. 2003;  24 1164-1166
• 5 Wasserman B N, Sprunger D T, Helveston E M. Comparison of materials used in frontalis suspension.  Arch Ophthalmol. 2001;  119 687-691
• 6 Smith R M, Goldwasser M S, Sabol S R. Erosion of a Teflon-Proplast implant into the middle cranial fossa.  J Oral Maxillofac Surg. 1993;  51 1268-1271
• 7 Chen J, Shih-Tseng L, Lui T et al.. Teflon granuloma after microvascular decompression for trigeminal neuralgia.  Surg Neurol. 2000;  53 281-287
• 8 Ozeren M, Han U, Mavioglu I et al.. Consequences of PTFE membrane used for prevention of re-entry injuries in rheumatic valve disease.  Cardiovasc Surg. 2002;  10 489-493
• 9 Kassam A, Snyderman C H, Mintz A et al.. Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica.  Neurosurg Focus. 2005;  19 1-12
• 10 Dedo H J. Injection and removal of Teflon for unilateral vocal cord paralysis.  Ann Otol Rhinol Laryngol. 1992;  101 81-86
• 11 Rubin H J. Misadventures with injectable polytef (Teflon).  Arch Otolaryngol. 1975;  101 114-116
• 12 Nakayama M, Ford C N, Bless D M. Teflon vocal fold augmentation: failures and management in 28 cases.  Otolaryngol Head Neck Surg. 1993;  109 493-498
• 13 Kirchner F R, Toledo P, Svoboda D. Studies of the larynx after Teflon injection.  Arch Otolaryngol. 1966;  83 350-354
• 14 Toomey J M, Brown B S. The histological response to intracordal injection of Teflon paste.  Laryngoscope. 1967;  77 110-120
• 15 Dedo H H, Carlsoo B. Histologic evaluation of Teflon granulomas of human vocal cords. A light and electron microscopic study.  Acta Otolaryngol. 1982;  93 475-484
• 16 Megerian C A, Busaba N Y, McKenna M J et al.. Teflon granuloma presenting as an enlarging, gadolinium enhancing, posterior fossa mass with progressive bilateral hearing loss following microvascular decompression.  Am J Otol. 1995;  16 783-786
• 17 Premsagar I C, Moss T, Coakham H B. Teflon-induced granuloma following treatment of trigeminal neuralgia by microvascular decompression. Report of two cases.  J Neurosurg. 1997;  87 454-457
• 18 Loehrl T A, Smith T L. Inflammatory and granulomatous lesions of the larynx and pharynx.  Am J Med. 2001;  111 113S-117S