Neurological Disorders

Textilloma Mimicking an Intracranial Postoperative Abscess

Abstract

Giovanni Tringali, Morgan Broggi, Giuseppe Didato, Ludovico D’Incerti, Angelo Franzini and Flavio Villani

Background: Achieving haemostasis during surgical procedures within the brain is of paramount importance. Bipolar cauterization is most effectively used to occlude identifiable vessels but it has minimal efficacy in controlling the oozing bleeding that characterises most neurological pathologies. In such cases chemical haemostatic agents are often preferable to bipolar cautery. Rarely these chemical agents may produce a foreign-body reaction that resembles infectious or malignant processes. On imaging significant oedema and ring-like enhancement on postcontrast studies may falsely confirm the suspect of such processes, requiring new surgical intervention.
Methods: In this report a reaction to a chemical haemostatic agent in a patient operated on for a low grade glioma causing focal epilepsy is discussed.
Results: After a two year follow-up the patient is seizure free without neurological deficits, and MRI scans do not show any significant focal alteration except for surgical scar.
Conclusions: The literature reports sporadic cases of foreign-body reaction to haemostatic agents that may mimic neoplastic recurrency or post-surgical infectious complications on imaging studies, but this complication is still considered exceedingly rare. Our case, however, confirms this possibility, raising the suspicion that it may be overlooked when imaging studies are not performed soon after surgery or if the reaction happens in a silent cerebral area.