Pseudotumorous reaction to hemostatic material. A new treatment approach illustrated by clinical cases

Introduction. Effective hemostasis is crucial in neurosurgical operations at the tumor/brain interface, where classical methods of bleeding control may be insufficient. The widely used oxidized cellulose material (Surgicel®, one of the most popular materials used in our operating rooms) rarely causes granulomatous reactions that can mimic tumor recurrence or an abscess. Objective of the study was to review two clinical cases of an inflammatory reaction to a hemostatic agent with successful conservative treatment and to discuss the existing literature on this issue.

Materials and methods. We present the clinical cases of two patients (17 and 10 years old) who underwent neurosurgical operations using oxidized cellulose hemostatic agents, after which an inflammatory reaction to the material developed. In both cases, anti-inflammatory therapy with prednisolone was administered, leading to the complete regression of symptoms, including radiological findings.

Results. Both patients exhibited a typical clinical picture of an inflammatory reaction to the hemostatic material, confirmed by neuroimaging (MRI) and laboratory data. Anti-inflammatory treatment with prednisolone provided a rapid therapeutic effect, avoiding the need for reoperation.

Conclusions. A reaction to the hemostatic material, such as granulomatous inflammation, requires careful differential diagnosis from tumor recurrence and abscess. In stable cases, successful conservative treatment is possible, avoiding unnecessary surgical interventions.

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