Surgicel™ application in intracranial hemorrhage surgery contributed to giant-cell granuloma in a patient with hypertension: case report and review of the literature

BACKGROUND: Surgicel™ is an oxidized cellulose preparation that is widely applied in neurosurgery due to its hemostatic effect and good tissue compatibility. Tumor-like lesions induced by Surgicel® application in cerebral surgery have been rarely reported, especially for intracranial hemorrhage debridement surgery in patients with hypertension. CASE PRESENTATION: This case report describes a rare case in which Surgicel™ application led to a foreign body reaction, contributing to the development of an intracranial giant-cell granuloma. A 49-year-old female hypertensive patient was diagnosed with intracranial hemorrhage. She was treated with debridement surgery that employed Surgicel™ application. Although a satisfactory hemostatic effect was achieved, the patient was diagnosed with epilepsy 6 months later. Subsequent magnetic resonance imaging revealed an intracranial space-occupying lesion. After undergoing en bloc resection of the lesion, the patient was diagnosed with a Surgicel™-related intracranial giant-cell granuloma by histopathology. CONCLUSIONS: Application of Surgicel™ during intracranial hemorrhage debridement surgery may be associated with a risk of granuloma development due to formation of a tumor-like space-occupying lesion in the surgery bed. Even a low risk of tumor development implies a need for caution when applying Surgicel™, especially when solely used to achieve a hemostatic effect.