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"Dural sealant-oma" after posterior fossa surgery: illustrative case
Nathan Fredricks1,2, Anthony M Price3, Christopher File1,2
1John Sealy School of Medicine, The University of Texas Medical Branch at Galveston, Texas.
Background:
Dural sealants, widely used in neurosurgical practice, have been associated with few complications, mostly relating to the expansive nature of the hydrogel. Although generally well tolerated, DuraSeal expands up to 150% after application, and rare reports have described complications from mass effect.
Observations:
This report presents the case of a 34-year-old female with a past surgical history of multiple operations for a Chiari type 1 malformation. After a thorough workup, intraoperative images and histological findings revealed a concealed hematoma-like mass at the patient's previous surgical site, likely due to the DuraSeal system. Imaging revealed that the DuraSeal was mostly hyperintense on T2-weighted MRI with focal spots of hypo-/isointensity, similar in appearance to an abscess or hematoma. Histological analysis showed exuberant fibrosis, granulation tissue, and a granulomatous response to the foreign material used for the dural patch and seal rather than the wall of an infectious abscess.
Lessons:
This case adds to the growing body of literature on DuraSeal, highlighting the imaging and histological characteristics of "dural sealant-omas" and their expansile nature that can lead to the formation of a mass mimicking an abscess or a hematoma. In areas susceptible to compression, clinicians ought to be vigilant to identify findings consistent with the appearance of these dural sealant-omas. https://thejns.org/doi/10.3171/CASE25574.
