625 Intracranial Gossypiboma Nine Years After Intracranial Pressure Bolt Insertion - A Case Report

Background Resorbable hemostatic agents are commonly used to control bleeding intra- and post- operatively. Once left behind, these agents can occasionally trigger pathological, granulomatous reactions, resulting in space-occupying lesions known as gossypibomas. Here we report a case of an intracranial gossypiboma. These are notoriously difficult to diagnose as they are exceedingly rare and frequently radiologically indistinguishable from other lesions (tumors, abscess etc). Case Presentation A 35-year-old woman presented with a generalized tonic-clonic seizure and subsequent left-sided hemiparesis. MRI demonstrated an enhancing lobulated lesion subjacent to a right frontal burr hole, surrounded by vasogenic edema with mass effect and midline shift. Nine years ago, she had a triple bolt inserted to monitor intracranial pressure after sustaining traumatic brain injury in a road traffic accident. Surgicel was used to control bleeding during insertion. She made a full recovery. Co-location of the lesion with the position of triple bolt nine years ago raised a suspicion for gossypiboma. However, the minor nature of the surgery, and the length of time since surgery to presentation were placing this case well outside range of cases reported in the literature. The lesion was resected en bloc, with no recurrence 18 months later. Histological examination revealed presence of foreign material, confirming the suspicion of Surgicel-elicited gossypiboma. Conclusions We show here that gossypibomas can occur following a relatively minor procedure and remain clinically and radiologically silent for much longer than what was previously reported. Thus, they should be included in differential diagnoses despite being remarkably rare.