Surgicel application in intracranial hemorrhage surgery contributed to giant-cell granuloma in a patient with hypertension: case report and review of the literature

World J Surg Oncol. 2014 Apr 21:12:101. doi: 10.1186/1477-7819-12-101.

Abstract

Background: Surgicel is an oxidized cellulose preparation that is widely applied in neurosurgery due to its hemostatic effect and good tissue compatibility. Tumor-like lesions induced by Surgicel application in cerebral surgery have been rarely reported, especially for intracranial hemorrhage debridement surgery in patients with hypertension.

Case presentation: This case report describes a rare case in which Surgicel application led to a foreign body reaction, contributing to the development of an intracranial giant-cell granuloma. A 49-year-old female hypertensive patient was diagnosed with intracranial hemorrhage. She was treated with debridement surgery that employed Surgicel application. Although a satisfactory hemostatic effect was achieved, the patient was diagnosed with epilepsy 6 months later. Subsequent magnetic resonance imaging revealed an intracranial space-occupying lesion. After undergoing en bloc resection of the lesion, the patient was diagnosed with a Surgicel-related intracranial giant-cell granuloma by histopathology.

Conclusions: Application of Surgicel during intracranial hemorrhage debridement surgery may be associated with a risk of granuloma development due to formation of a tumor-like space-occupying lesion in the surgery bed. Even a low risk of tumor development implies a need for caution when applying Surgicel, especially when solely used to achieve a hemostatic effect.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Cellulose, Oxidized / administration & dosage
  • Cellulose, Oxidized / adverse effects*
  • Female
  • Granuloma, Giant Cell / etiology*
  • Humans
  • Hypertension / complications
  • Hypertension / surgery*
  • Intracranial Hemorrhages / complications
  • Intracranial Hemorrhages / surgery*
  • Magnetic Resonance Imaging
  • Middle Aged
  • Postoperative Complications / etiology*
  • Prognosis

Substances

  • Cellulose, Oxidized
  • Surgicel