Teflon Granuloma of the Skull Base: A Complication of Endonasal Brain Surgery

Abstract

Teflon granuloma is an inflammatory giant-cell foreign-body reaction to polytetrafluoroethylene fibers or injection. Tissue augmentation with Teflon has dramatically declined over the past two decades because of its implication in granuloma formation. Nevertheless, Teflon felt is still commonly used in neurosurgical dissection and microvascular decompression. We report a patient with a Teflon granuloma of the skull base discovered 1.5 years after endonasal resection of an olfactory groove meningioma. The case highlights the clinical and radiographic diagnosis as well as the management of this unusual finding.

Teflon granulomas mimicking cerebellopontine angle tumors following microvascular decompression

“…A), vessels, and the brainstem, and may exert mass effect as they grow, precipitating recurrent facial pain, new‐onset facial numbness, facial paralysis, or hearing loss . Aseptic meningitis, brain abscess, and intracranial cysts leading to neurologic deficits have been described in isolated cases . TG may grow and become symptomatic at variable intervals, ranging from within 1 month to over 8 years following primary surgery .…”

“…Prevention of TG via surgical technique modification is unproven, but previous authors have recommended limiting contact between Teflon with the tentorium or dura, as well as restricting pledget positioning such that the Teflon is completely contained within the cisterns . Minimizing the volume of Teflon implanted and maintaining a hemostatic surgical field may also lower the incidence of this rare complication …”

“…1,4,5,[7][8][9] During microvascular decompression (MVD), Teflon is the standard material used to displace the aberrant, symptom-inducing vascular loop characteristically underlying trigeminal neuralgia or hemifacial spasm, and pad the compressed cranial nerve at the root exit zone (REZ). [10][11][12] Intracranial Teflon granuloma (TG) occurs most frequently in the prepontine cistern after MVD for trigeminal neuralgia, with an incidence ranging from 1% to 7%. 10,[13][14][15][16][17][18] However, development of TG after MVD for hemifacial spasm, and involvement of the CPA, is exceptionally less common, with only one previous report in the English literature.…”

Treatment of recurrent trigeminal neuralgia due to Teflon granuloma

“…While bacterial infection has been thought to play a role in a Teflon granuloma in a patient who underwent an endonasal approach for a skull base tumor, there is no clue that this might be relevant in granuloma after MVD [36]. …”

Recurrent Hemifacial Spasm following Minor Trauma: Report of a Case

“…While unusual, this case of clear pledget migration stimulates evaluation of the most appropriate graft material for MVD and alterations in technique at reoperation. Fibrin glue offers an alternative to Teflon pledgets for vessel translocation, avoiding rare but potentially serious complications such as granuloma formation [6][7][8][9] . However, fibrin carries its own reported consequences [10] .…”