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. 2022 May 16;3(20):CASE22126.
doi: 10.3171/CASE22126. Print 2022 May 16.

Conservative management of intraventricular migration of a gelatin sponge: illustrative case

Katherine G Holste  1 , Bridger Rodoni  2 , Arushi Tripathy  1 , Jaes C Jones  1 , Sara Saleh  1 , Hugh J L Garton  1
Affiliations

Conservative management of intraventricular migration of a gelatin sponge: illustrative case

Katherine G Holste et al. J Neurosurg Case Lessons. .

Abstract

Background: Gelatin sponges, such as Gelfoam, are used as hemostatic agents during surgery and are generally absorbed over the course of 4-6 weeks in most body cavities. The time course of the dissolution of Gelfoam sponges within the cerebral ventricles has not been described.

Observations: The authors present a case of intraventricular migration of Gelfoam after ventriculoperitoneal shunt placement in a 6-week-old infant. The infant was imaged regularly after ventriculoperitoneal shunt placement, and the Gelfoam sponge persisted within the ventricles on all images until 11 months after surgery. At no time during follow-up did the patient have any symptoms of hydrocephalus requiring retrieval of the sponge or shunt revision.

Lessons: This is the first case describing time until absorption of a gelatin sponge within the ventricle and successful conservative management.

Keywords: Gelfoam; hydrocephalus; neurosurgery; shunt.

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Conflict of interest statement

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Figures

FIG. 1.
FIG. 1.
Preoperative cranial ultrasound showing hydrocephalus.
FIG. 2.
FIG. 2.
Postoperative day 1 cranial ultrasound shows a hyperechoic, rectangular object (red arrow) within the atrium of the right lateral ventricle consistent with a migrated gelatin sponge.
FIG. 3.
FIG. 3.
Formal MRI performed 2 weeks after surgery shows the same gelatin sponge within the right occipital horn. Left: The sponge (red arrow) is present on T2-weighted MRI and appears isointense to white matter and hyperintense to gray matter. Right: The sponge (red arrow) is more visible on the fluid-attenuated inversion recovery sequence, in which it is hyperintense to CSF and hypointense to brain matter.
FIG. 4.
FIG. 4.
A: Routine follow-up MRI shows persistence of the sponge (red arrow) at 7 weeks after surgery on a T2-weighted sequence. B: Routine MRI performed at 15 weeks after surgery shows that the sponge (red arrow) is still present but much smaller in size. In addition, the ventricles have started to decompress. C: Routine follow-up MRI at 11 months shows dissolution of the gelatin sponge. Accounting for differences in the gantry between the MRI studies, the ventricles are much smaller and well decompressed by the shunt.
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