Objective: The study presents a clinical observation of foreign body granuloma, which is rare productive inflammation, developed on treatment with a hemostatic material upon removal of cerebral cavernoma.
Material and methods: A 4-year-old boy operated on for left parietal lobe cavernoma was diagnosed with a mass lesion during a follow-up MRI examination 4 months after surgery. The patient was re-operated in connection with suspected abscess formation. The pathological tissue was subjected to the histological and immunohistochemical examination.
Results: Inflammation was accompanied by the formation of foreign body granulomas, and, in some areas, had immune nature with signs of focal destructive vasculitis, delayed maturation of the granulation tissue, and disturbance of the current organization and encapsulation processes. It is worth noting that granulomatous inflammation around a hemostatic material in the brain has no specific features during introscopy and mimics an abscess or tumor recurrence.
Conclusion: The use of hemostatic materials upon resection of cerebral cavernous malformations may cause formation of granuloma mimicking disease relapse or abscess in the long term period. To prevent granulomatous inflammation, removal of a hemostatic material, if possible, from the surgical field is recommended when reliable hemostasis is achieved.
Описывается редкое клиническое наблюдение продуктивного гранулематозного воспаления, вызванного гемостатическим материалом на основе желатина, в ложе удаленной каверномы левой теменной доли головного мозга у мальчика 4 лет, которое было выявлено через 4 мес после операции при плановом МРТ-обследовании. Воспаление сопровождалось образованием гранулем типа инородных тел и на отдельных участках принимало характер иммунного с явлениями очагового деструктивного васкулита, задержкой созревания грануляционной ткани и нарушением процессов организации и инкапсуляции. Обсуждаются вопросы дифференциальной диагностики и тактики хирургического лечения.