[Intracranial foreign body granuloma caused by fine cotton fibers: a case report]

Abstract

Reported here is a rare case of intracranial foreign body granuloma caused by fine cotton fibers originating from the cotton sheet, which was used in the previous operation. The patient was a 54-year-old woman who presented with headache and right hemiparesis. CT scan demonstrated a large enhanced tumor in the left temporal lobe. During the operation, the tumor bled easily and was hard to remove. The brain surface was covered with oxidized cellulose (Oxycell) after the tumor was subtotally removed. Cotton sheets (Surgical Patty) were also used during the operation. The microfibrillar collagen hemostat (Avitene) was not applied. The histological diagnosis was astrocytoma. Radio-chemotherapy was given. CT and MRI on the 40th day after the operation, showed a large tumor in the left temporal lobe, which led to suspicions of tumor recurrence. The second operation disclosed a mass which was harder in consistence than the previous one. The histological diagnosis was foreign body granuloma, which contained a lot of fine cotton fibers. Oxycell was not found in it. The cotton-sheet is well documented as a cause of granuloma in the literature, but it is seldom mentioned that the foreign body granuloma is caused by cotton fibers, scattered in the operative fields. This case report suggests the possibility of cotton-fiber granuloma and our simple experiment indicated that a lot of cotton fiber might be scattered in the operative fields, if dry cotton sheets are used. These results stress that washed cotton sheets should be applied to avoid the possibility of the development of cotton-fiber foreign body granuloma.