1 - Neuroradiology Department, Hospital de São José, Centro Hospitalar Lisboa Central, Lisbon, Portugal
2 - Pediatric Neurosurgery Department, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, Lisbon, Portugal
3 - Neuroradiology Department, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, Lisbon, Portugal
- 45th ESNR Annual Meeting, 14-18 Setembro, Lisboa
- Neuroradiology (2022) 64 (Suppl 1):S1-S165 https://doi.org/10.1007/s00234-022-03012-w
Introduction: Textilomas are defined as expansile inflammatory/granulomatous lesions that arise in the surgical bed as a response to hemostatic material. Textiloma formation in a tumor-resected area can be alarming and lead to invasive unnecessary procedures. Therefore, even though they are extremely rare, this diagnosis is of uttermost importance with dramatic changes to the approach, preventing invasive procedures. MRI can help differentiating textiloma from a true tumor residue or recurrence based on its characteristics: lower T2 signal, lack of restricted diffusion and a “ring and bubble” enhancing pattern. A conservative and watchful approach with close follow-up will reveal a progressively decreasing lesion with eventual spontaneous resolution.
Methods: We reviewed the resected tumors data base from our pediatric tertiary center from the last 10 years to identify the cases that matched these imaging characteristics.
Results: In the aforementioned period, we found 3 cases of post-tumor resection textilomas that occurred in the last trimester of 2020. We hereby describe these clinical cases and their MR findings that are in accordance with the literature. All the 3 cases were closely followed-up and revealed progressive resolution.
Discussion & Conclusion: Textilomas in a tumor-resected area are a very rare entity but represent a potential harm for patients when misinterpreted. Its diagnosis can change the medical approach and prevent unnecessary invasive procedures. When retrospectively reviewing our resected tumors database we found 3 cases of post-tumor resection textilomas, all happening in a recent time, without any prior case in the other past 10 years. After investigating we found that the surgical oxidized cellulose and hemostatic gel brands had been replaced just before the surge of these cases. In our understanding, even though we could not confirm in which patients the new material had been used, this material change might be the cause of the sudden occurrence of textilomas, which to our knowledge had never happened before. The decrease and progressive resolution in all our cases highlight the importance of a conservative watchful and non-invasive approach.
Palavras Chave: Textilomas; brain surgery; MRI; hemostatic material