Chishti, M. K. N.

Razzaq, Ashfaq A

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eCommons@AKUSection of Neurosurgery Department of SurgeryDecember 2000Foreign body granuloma after craniotomy fortumor: a diagnostic dilemmaA A. RazzaqM K. ChishtiFollow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_neurosurgPart of the Surgery CommonsRecommended CitationRazzaq, A. A., Chishti, M. K. (2000). Foreign body granuloma after craniotomy for tumor: a diagnostic dilemma. British Journal ofNeurosurgery, 14(6), 591-592.Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_neurosurg/130Full Terms & Conditions of access and use can be found athttps://www.tandfonline.com/action/journalInformation?journalCode=ibjn20British Journal of NeurosurgeryISSN: 0268-8697 (Print) 1360-046X (Online) Journal homepage: https://www.tandfonline.com/loi/ibjn20Foreign body granuloma after craniotomy fortumor: a diagnostic dilemmaA. A. Razzaq, M. K. N. ChishtiTo cite this article: A. A. Razzaq, M. K. N. Chishti (2000) Foreign body granuloma aftercraniotomy for tumor: a diagnostic dilemma, British Journal of Neurosurgery, 14:6, 591-592, DOI:10.1080/02688690020005617To link to this article:  https://doi.org/10.1080/02688690020005617Published online: 06 Jul 2009.Submit your article to this journal Article views: 12Citing articles: 3 View citing articles British Journal of Neurosurgery 2000; 14(6): 591± 592NEUROLOGICAL IMAGEForeign body granuloma after craniotomy for tumor: a diagnosticdilemmaA.A. RAZZAQ & M. K. N. CHISHTIDepartment of Surgery, Division of Neurological Surgery, Aga Khan University Hospital, Karachi, PakistanAn unusual case of foreign body reaction after resec-tion of tumour is described. A 45-year-old womanpresented with a complaint of generalized headacheof 2 years duration. Neurological examination showedbilateral papilloedema and a right hemiparesis.Contrast CT showed an enhancing, deep seated lefthemispheric mass, centred on the left lateral ventricle(Fig. 1A). The patient underwent a left parietalcraniotomy. The tumour was found completelyembedded in the brain substance. It was about 8 mmCorrespondence: Ashfaq A. Razzaq, 56/2, Lane 17, Phase 7, DHA, Karachi, Pakistan, E-mail: ashfaq@akunet.org.Received for publication 20 July 1999. Accepted 13 March 2000.FIG. 1. (A upper left) Contrast-enhanced preoperative CT scan showing intensely enhancing lesion centred on the leftlateral ventricle. (B lower left) Contrast-enhanced postoperative CT scan showing no evidence of residual tumour. (C upperright) Contrast-enhanced CT scan 40 days after initial operation showing ring enhancing lesion near the site of previoustumour resection (D, lower right) Histology of the lesion showing foreign body reaction with giant cells (H & E).ISSN 0268± 8697 print/ISSN 1360± 046X online/00/060591± 02 ½ The Neurosurgical FoundationDOI: 10.1080/02688690020005617from the brain surface, was ® rm in consistency andwas removed completely. No dural or ventricularattachment was visible at operation. The pathologywas benign transitional meningioma. Postopera-tively, CT showed no evidence of residual tumour(Fig. 1B). Nearly three months after operation thepatient presented with high grade fever and general-ized tonic-clonic seizures. CT showed an enhancing23 3 cm lesion deep in the left hemisphere (Fig. 1C).The diagnostic possibilities of recurrent tumour andabscess were considered, and it was decided tore-operate. In the depths of the previous corti-cotomy, an irregular, grayish brown mass wasencountered, pressing on the medial side of thetemporal horn. It resembled tumour on gross appear-ance and was resected with some difficulty, owing toadhesions with the surrounding tissue.The histologyrevealed chronic granulomatous in¯ ammation withgiant cells containing birefringent material which werecotton ® bres (Fig. 1D). Postoperatively, the patient’scondition improved gradually and seizures werecontrolled.The differential diagnosis of an enhancing massafter craniotomy for tumour includes recurrent orresidual tumour, abscess and radiation necrosis.1 Thisreport emphasizes the importance of adding foreignbody granuloma to this list and to avoid using cottonballs in deep cavities.2 ± 5 Early recognition of thisentity may prevent major morbidity resulting fromthis condition.References1 Shimosaka S, Waga S. Foreign body granulomasimulating recurrence of falx meningioma. J Neurosurg1983;59:1085± 7.2 Haisa T, Matsumiya K, et al. Foreign body granulomaas a complication of wrapping and coating an intracra-nial aneurysm. J Neurosurg 1990;72:292± 4.3 Chambi I, Tasker RR, Gentili F, et al. Gauze-inducedgranuloma (gauzoma): an uncommon complication ofgauze reinforcement of berry aneurysms. J Neurosurg1990; 72: 163± 70.4 Epstein AJ, Russell EJ, Berlin L, et al. Suture granu-loma: an unusual cause of an enhancing ring lesion inthe post-operative brain. J Comput Assist Tomogr1982;6:815± 17.5 Korosue K,Tamaki N,Matsumoto S, et al. Intracranialgranuloma as an unusual complication of subdural-peritoneal shunt. Case report. J Neurosurg1981;55:136± 8.592 A.A. Razzaq & M.K.N. Chishti

Foreign body granuloma after craniotomy for tumor: A diagnostic dilemma

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Foreign body granuloma after craniotomy for tumor: A diagnostic dilemma

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