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Magnetic resonance imaging showing a new contrast enhancing mass in the frontal lobe at the site of prior abscess.
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Introduction:
Cranial-retained surgical sponges (gossypiboma or textiloma) are rare incidents and mostly asymptomatic. However, they can be confused with other masses such as a hematoma abscess or tumor. During early stages, some gossypibomas can cause infection or abscess formation.
Case presentation:
A 22-year-old Turkish female who had fronta...
Citations
... For this reason, it is important to consider inter-and intraquantification discrepancies to allow for a better interpretation of potential bias of AI methods' performance as they may produce results that differ from the true underlying estimate [25]. Other future directions that are related to the improvement of AI methods for ICH segmentations may also explore the effect of negative training subjects on the AI's performance [26][27][28]. Several limitations deserve to be addressed. ...
Background and purpose:
Fully automated methods for segmentation and volume quantification of intraparenchymal hemorrhage (ICH), intraventricular hemorrhage extension (IVH), and perihematomal edema (PHE) are gaining increasing interest. Yet, reliabilities demonstrate considerable variances amongst each other. Our aim was therefore to evaluate both the intra- and interrater reliability of ICH, IVH and PHE on ground-truth segmentation masks.
Methods:
Patients with primary spontaneous ICH were retrospectively included from a German tertiary stroke center (Charité Berlin; January 2016-June 2020). Baseline and follow-up non-contrast Computed Tomography (NCCT) scans were analyzed for ICH, IVH, and PHE volume quantification by two radiology residents. Raters were blinded to all demographic and outcome data. Inter- and intrarater agreements were determined by calculating the Intraclass Correlation Coefficient (ICC) for a randomly selected set of patients with ICH, IVH, and PHE.
Results:
100 out of 670 patients were included in the analysis. Interrater agreements ranged from an ICC of 0.998 for ICH (95% CI [0.993; 0.997]), to an ICC of 0.979 for IVH (95% CI [0.984; 0.993]), and an ICC of 0.886 for PHE (95% CI [0.760; 0.938]), all p-values < 0.001. Intrarater agreements ranged from an ICC of 0.997 for ICH (95% CI [0.996; 0.998]), to an ICC of 0.995 for IVH (95% CI [0.992; 0.996]), and an ICC of 0.980 for PHE (95% CI [0.971; 0.987]), all p-values < 0.001. Conclusion Manual segmentations of ICH, IVH, and PHE demonstrate good-to-excellent inter- and intrarater reliabilities, with the highest agreement for ICH and IVH and lowest for PHE. Therefore, the degree of variances reported in fully automated quantification methods might be related amongst others to variances in ground-truth masks.
... Thus, it is unsurprising that surgical sponges are the most commonly retained items (6). Unfortunately, retained foreign body objects may lead to life-threatening immunologic responses, require reoperation, or cause intracranial textilomas and gossypibomas, which mimic tumors immunologically and radiologically (7)(8)(9)(10). Locating cotton balls on or around the brain becomes increasingly challenging as they absorb blood, rendering them visually indistinguishable from the surrounding tissue. ...
Objects accidentally left behind in the brain following neurosurgical procedures may lead to life-threatening health complications and invasive reoperation. One of the most commonly retained surgical items is the cotton ball, which absorbs blood to clear the surgeon’s field of view yet in the process becomes visually indistinguishable from the brain parenchyma. However, using ultrasound imaging, the different acoustic properties of cotton and brain tissue result in two discernible materials. In this study, we created a fully automated foreign body object tracking algorithm that integrates into the clinical workflow to detect and localize retained cotton balls in the brain. This deep learning algorithm uses a custom convolutional neural network and achieves 99% accuracy, sensitivity, and specificity, and surpasses other comparable algorithms. Furthermore, the trained algorithm was implemented into web and smartphone applications with the ability to detect one cotton ball in an uploaded ultrasound image in under half of a second. This study also highlights the first use of a foreign body object detection algorithm using real in-human datasets, showing its ability to prevent accidental foreign body retention in a translational setting.
... [1][2][3] Intracranial textilomas are very rare with only few case reports available in literature. 4 Through this article we intend to describe the spectrum of imaging findings in intracranial textilomas through clinicoradiological discussion of four postoperative cases. We took our institutional ethical committee clearance for this study. ...
... MRI appearances might vary depending on the type of material left, timing of MRI scan, and the location of the hemostatic agent. 4 On conventional sequences, most of these agents appear as well demarcated focal lesions mostly hypointense on T1-weighted (T1W) sequence. Signal changes on T2W images could be hyperintense-hypointense depending on the fluid and protein contents. ...
Background and Importance Intracranial textilomas are retained surgical sponges presenting as pseudomass lesions in postoperative patients usually with surrounding inflammatory reaction. Though rare, these are commonly misdiagnosed as postoperative hemorrhagic collections, abscesses, radionecrosis, or residual/recurrent mass lesions. We describe the imaging findings of intracranial textilomas diagnosed in four patients on follow-up postoperative imaging along with their characteristic imaging findings to help radiologists/neurosurgeons make accurate diagnosis.
Clinical Presentation One patient had chronic headache without any focal neurological deficits. Rest of the patients were asymptomatic at the time of presentation
Conclusion In postoperative scans, possibility of textilomas should be considered apart from residual/recurrent lesions, postoperative abscesses, or radionecrosis. Correct and timely diagnosis is important for further treatment planning and patient care.
... This case series highlights characteristic clinico-radiographic and histopathological features and management considerations in six individual patients affected by intracranial FBG, an important differential diagnosis in postsurgical neuro-oncological patients with de novo imaging findings. Correct imaging-based diagnostic differentiation of intracranial FBG from malignancy, abscess, hemorrhage, and other treatment-related conditions prior to surgery is seldom possible [2,5,6,9,10] and has only been reported in 6% of published cases [3]. Consistent with the literature, diagnosis of intracranial FBG in our series was established mostly within the first few months postsurgery [3,4]. ...
Background:
Intracranial foreign body granuloma (FBG) is a rare inflammatory reaction to retained foreign material, manifesting acutely or months to years following neurosurgical procedures. Radiographically, FBG can mimic tumor progression and tissue biopsy may be required to guide management.
Methods:
In this retrospective case series, we present unique clinico-radiographic and histopathological features of six neuro-oncological patients diagnosed with FBG between 2007 - 2019.
Results:
All 6 patients (4 females and 2 males, aged 29 - 54 [median 30.5] years) had undergone surgical resection of a low (n=4) or high grade (n=2) glioma. FBG manifestation post-surgery ranged from 1 day to 4 years and was predominantly asymptomatic (n=5/6). MR imaging universally demonstrated one or multiple peripherally enhancing lesion(s) adjacent to the resection cavity. Histopathology in all (n=4/4) resected specimens demonstrated an inflammatory reaction to foreign material, confirming FBG.
Conclusion:
Intracranial FBG constitutes a rare but challenging treatment-related condition effectively managed by surgery, with important therapeutic implications in neuro-oncology.
... Since 1973, 50 cases of intracranial textiloma have been recorded [2,3]. Because the incidence of retained cotton is likely underreported, the true frequency of these events is unknown [2]. ...
... Since 1973, 50 cases of intracranial textiloma have been recorded [2,3]. Because the incidence of retained cotton is likely underreported, the true frequency of these events is unknown [2]. However, approximately half of malpractice cases involve retained foreign objects, and these cases can result in costly lawsuits for hospitals [2]. ...
... Because the incidence of retained cotton is likely underreported, the true frequency of these events is unknown [2]. However, approximately half of malpractice cases involve retained foreign objects, and these cases can result in costly lawsuits for hospitals [2]. At present, there is no reliable means of detection for retained cotton balls before surgical closure, and previous reports emphasize the need for meticulous irrigation and inspection of the operative site prior to closure [1]. ...
Cotton balls are a versatile and efficient tool commonly used in neurosurgical procedures to absorb fluids and manipulate delicate tissues. However, the use of cotton balls is accompanied by the risk of accidental retention in the brain after surgery. Retained cotton balls can lead to dangerous immune responses and potential complications, such as adhesions and textilomas. In a previous study, we showed that ultrasound can be safely used to detect cotton balls in the operating area due to the distinct acoustic properties of cotton compared with the acoustic properties of surrounding tissue. In this study, we enhance the experimental setup using a 3D-printed custom depth box and a Butterfly IQ handheld ultrasound probe. Cotton balls were placed in variety of positions to evaluate size and depth detectability limits. Recorded images were then analyzed using a novel algorithm that implements recently released YOLOv4, a state-of-the-art, real-time object recognition system. As per the radiologists' opinion, the algorithm was able to detect the cotton ball correctly 61% of the time, at approximately 32 FPS. The algorithm could accurately detect cotton balls up to 5mm in diameter, which corresponds to the size of surgical balls used by neurosurgeons, making the algorithm a promising candidate for regular intraoperative use.
... 3 As sequelae of retained cotton may not present for months or years postoperatively, and because incidences of retained cotton are likely underreported, the true frequency of these events is unknown. 5,6 Retained cotton may require an additional operation, which places the patient at greater risk. These incidents may cost hospitals and healthcare providers millions of dollars from malpractice lawsuits. ...
... Published studies of retained surgical cotton in neurosurgery focus on drawing attention to the problem and analyzing specific cases, but few have offered actual solutions to this problem. 5,7,8,9 Most authors advise surgeons to be aware of the possible dangers of an intracranial textiloma. 3,8 Thus, a method to locate cotton before closing is paramount to preventing textiloma. ...
Cotton balls are used in neurosurgical procedures to assist with hemostasis and improve vision within the operative field. Although the surgeon can reshape pieces of cotton for multiple intraoperative uses, this customizability and scale also places them at perpetual risk of being lost, as blood-soaked cotton balls are visually similar to raw brain tissue. Retained surgical cotton can induce potentially life-threatening immunologic responses, impair postoperative imaging, lead to a textiloma or misdiagnosis, and/or require reoperation. This study investigated three imaging modalities (optical, acoustic, and radiographic) to find the most effective method of identifying foreign bodies during neurosurgery. First, we examined the use of dyes to increase contrast between cotton and surrounding parenchyma (optical approach). Second, we explored the ability to distinguish surgical cotton on or below the tissue surface from brain parenchyma using ultrasound imaging (acoustic approach). Lastly, we analyzed the ability of radiography to differentiate between brain parenchyma and cotton. Our preliminary testing demonstrated that dark-colored cotton is significantly more identifiable than white cotton on the surface level. Additional testing revealed that cotton has noticeable different acoustic characteristics (eg, speed of sound, absorption) from neural tissue, allowing for enhanced contrast in applied ultrasound imaging. Radiography, however, did not present sufficient contrast, demanding further examination. These solutions have the potential to significantly reduce the possibility of intraoperative cotton retention both on and below the surface of the brain, while still providing surgeons with traditional cotton material properties without affecting the surgical workflow.
... Hemostatic materials commonly used for hemostasis may cause a granulomatous reaction that may produce space-occupying mass lesions termed textiloma (or gossypiboma) that are clinically or radiologically apparent. Intracranial body granuloma reactions initially provoke no clinical symptoms, but they may appear months or even years after surgical procedure [1][2][3][4]. All classes of hemostatic agents may cause a granulomatous reaction that may mimic recurrent or progressive intracranial tumor, radiation necrosis, abscess, resolving infarction, or intracranial rebleeding on postoperative imaging studies, depending on the particular clinical history of each patient. ...
... Gelatin sponges were introduced into surgical practice more than 50 years ago. Since that time granulomatous reactions to gelatin foam (Gelfoam), as well as to oxidized cellulose (Oxycel), oxidized regenerated cellulose (Surgicel), microfibrillar collagen (Avitene), or nonabsorbable materials including various forms of cotton pledgets and cloth (such as muslin), have been reported after neurosurgical operations [1,[4][5][6][7][8][9][10][11][12][13][14]. These agents are usually removed prior to surgical closure, except in the case of muslin, which is used to reinforce unclippable intracranial aneurysms [12]. ...
... These agents are usually removed prior to surgical closure, except in the case of muslin, which is used to reinforce unclippable intracranial aneurysms [12]. Granulomatous reactions due to hemostatic agents have been reported experimentally [15], as well as after cranial [1, 4-6, 8, 9, 11-14] and spinal [1,10,16] operations. Fibrin sealant has not been reported in the neurosurgical literature as the source of a granulomatous reaction [9]. ...
During craniotomy, hemostatic materials such as oxidized cellulose and cotton pads, commonly used to control bleeding, may cause a granulomatous reaction that may produce space-occupying mass lesions termed textiloma (or gossypiboma). We present a 46-year-old female who underwent a right frontotemporal craniotomy and surgical removal of intraparenchymal cerebral hemorrhage, and who developed a textiloma during the postoperative period causing seizures. Granulomatous reactions due to hemostatic agents have been reported experimentally, as well as after cranial and spinal operations. We emphasize that although it is rare, an adverse reaction such as a postoperative textiloma due to hemostatic material and subsequent granuloma formation can result in a false image of rebleeding, tumor recurrence, radiation necrosis, or postoperative abscess, depending on the particular clinical history of each patient.
... In turn, activated macrophages produce interleukin-1 family cytokines and tumor necrosis factor which determine further macrophage activation and their fusion into multinucleated giant cells. After months, transforming growth factor beta releasing recruits and activates fibroblasts with fibrous capsule development shows a mass with heterogeneous signal on T1w, central hyperintensity with peripheral hypointensity on T2w images, and post-contrast ring-enhancement [7,8]. Extra-axial granulomas appear as a nodular formation, heterogeneously hypointense on T2w images, and with a thin rim of contrast enhancement [9]. ...
Intra-cranial and spinal foreign body reactions represent potential complications of medical procedures. Their diagnosis may be challenging as they frequently show an insidious clinical presentation and can mimic other life-threatening conditions. Their pathophysiological mechanism is represented by a local inflammatory response due to retained or migrated surgical elements. Cranial interventions may be responsible for the presence of retained foreign objects represented by surgical materials (such as sponges, bone wax, and Teflon). Spinal diagnostic and therapeutic procedures, including myelography, chordotomy, vertebroplasty, and device implantation, are another potential source of foreign bodies. These reactions can also follow material migration or embolization, for example in the case of Lipiodol, Teflon, and cement vertebroplasty. Imaging exams, especially CT and MRI, have a central role in the differential diagnosis of these conditions together with patient history. Neuroradiological findings are dependent on the type of material that has been left in or migrated from the surgical area. Knowledge of these entities is relevant for clinical practice as the correct identification of foreign bodies and related inflammatory reactions, material embolisms, or migrations can be difficult. This pictorial review reports neuroradiological semeiotics and differential diagnosis of foreign body-related imaging abnormalities in the brain and spine.
... Sin embargo, la importancia de este documento radica en los aspectos abordados en cuanto a sinte tizar la evidencia disponible sobre la presencia de gossypibomas o textilomas en los procedimientos quirúrgicos en neurocirugía y contemplar que, en pacientes con historia de intervenciones neuroqui rúrgicas, esta patología debe considerarse dentro de los diagnósticos diferenciales de las complica ciones posquirúrgicas inmediatas, mediatas y tar días [21,22]. ...
... Tabla. Publicaciones de gossypiboma (cont.).Akpinar et al[21] 22 años Femenino Esponja quirúrgica Cirugía en el lóbulo frontal para la remoción del absceso 2 meses Cefalea y vómitos Naama et al [22] 42 años Femenino Esponja quirúrgica Laminectomía más discectomía 6 años Lumbalgia irradiada al miembro inferior derecho 50 años); sin embargo, no se pudo realizar una aso ciación entre las variables al tratarse de una mues tra pequeña que no representa la población general, por lo que se considera este hallazgo como una ob servación del estudio [1618]. Los síntomas en este trabajo estuvieron presen tes en el 94,4% de los casos, diferente a lo descrito por Tan y Sethi, quienes mencionan que los gossy pibomas son sintomáticos sólo en el 19%, y Okten et al, que aseveran que las reacciones a un cuerpo extraño crónicas cursan a menudo sin manifesta ciones clínicas [1820]. ...
Introducción. El término ‘gossypiboma’ proviene del latín gossypium, que hace referencia a un género de plantas de algo-dón, y de la palabra kiswahili boma, que se traduce como ‘lugar de escondite’. Puede confundirse con lesiones tumorales o abscesos debido a la forma de encapsulación evidenciada en los exámenes imaginológicos y su clínica variable e inespe-cífi ca, situación que genera difi cultad para el diagnóstico y una morbilidad importante. Objetivo. Sintetizar la evidencia disponible sobre la presencia de gossypibomas durante la realización de procedimientos quirúrgicos en neurocirugía. Desarrollo. Se realizó una revisión en la cual se incluyó una búsqueda de artículos en inglés y castellano publicados en los últimos 15 años en PubMed, Ebsco Host, Embase, Mediclatina, Cochrane, Lilacs y Scopus, entre enero y junio de 2019, utilizando las palabras clave ‘gossypiboma’, ‘textiloma’, ‘neurosurgery’ y ‘neurosurgical procedures’. El total de artículos encontrados en la búsqueda fue de 630; sin embargo, tras la selección por título y resumen fueron 22 los artículos de in-forme de caso que se incluyeron. Se identifi có a un total de 36 individuos, de los cuales 21 (58,3%) eran mujeres, y cuya edad media era de 56,1 años. En 20 casos (55,6%) se observaron esponjas quirúrgicas como gossypibomas. Conclusiones. El gossypiboma es una complicación secundaria a procedimientos quirúrgicos, con signos y síntomas bas-tante inespecífi cos. Su tiempo de aparición suele oscilar entre unos cuantos días hasta varios años después de realizada la cirugía y se correlaciona con múltiples implicaciones médicas y legales.Palabras clave. Discectomía. Gossypiboma. Granuloma. Laminectomía. Neurocirugía. Período perioperatorio. Procedimien-tos neuroquirúrgicos
(PDF) Gossypibomas en neurocirugía. Available from: https://www.researchgate.net/publication/336892835_Gossypibomas_en_neurocirugia [accessed Jan 13 2020].
... Warfarin sodium acts as an antagonist of vitamin K. Smoking causes thrombosis (8) . If there is an acute neurologic regression, absorbable hemostatic agents should always be thought in differential diagnosis (1,11) . It usually appears within the first Figure 11. ...
