Delayed cauda equina compression caused by BioGlue®-induced granulomatous reaction following spinal dural repair: A
Hazem Alkatreeb1, Laila Tarek Abbas Metwaly2, El Fatih Bashir El Malik1
1Department of Neurosurgery, Al Ahli Hospital, Doha, Qatar.
Background:
Adjunctive dural sealants such as BioGlue® are widely used to reinforce dural closure in cranial and spinal surgery. While generally effective, BioGlue® has been associated with inflammatory foreign-body reactions that may lead to delayed mass formation and neural compression. These delayed complications can mimic the original pathology. Here, a 66-year-old male underwent primary dural closure that included the use of BioGlue, which, 6 months later, caused the delayed onset of a cauda equina syndrome.
Case Description:
A 66-year-old male presented with sciatica secondary to focal L4-5 lumbar spinal canal stenosis and an intradural schwannoma at the L3 level. He underwent an L3-L5 laminectomy for resection of the tumor and decompression of the stenosis. At surgery, primary dural closure was reinforced with a muscle graft, combined with the utilization of BioGlue® and Gel-Foam®. Six months later, he developed a partial cauda equina syndrome attributed to an magnetic resonance imaging-documented heterogeneous extradural mass at the prior durotomy site. Surgical re-exploration allowed for resection of a newly occurring granulomatous mass at the prior operative site, comprised largely of residual BioGlue®. Histopathology confirmed that this represented a foreign-body granulomatous reaction to the BioGlue. Postoperatively, the patient demonstrated rapid neurological improvement.
Conclusion:
BioGlue®-induced granuloma represents an important delayed complication of spinal dural repair that can closely mimic recurrent pathology (i.e., in this case, stenosis and/or tumor).
