Unusual complications of bone wax at the skull base

Abstract

Objective This study aimed to describe the clinical presentation, microbiological profile and management of complications of bone wax usage for surgical procedures at the skull base. Method The case records of a series of five patients who developed post-operative surgical site complications because of bone wax usage during skull base surgery were reviewed. Results In all five patients, persistent site-specific clinical features were noted along with intra-operative presence of excessive bone wax. Three unique cases of presentation, one with a fungal brain abscess because of Aspergillus flavus infection, another with fungal osteomyelitis because of Trichosporon beigelii infection and a third with intradural migration of bone wax into the cerebellopontine angle cistern are highlighted. Conclusion The presentation of surgical site infection at the skull base because of excessive use of bone wax can be manifold. The need for testing appropriate cultures including fungal culture is highlighted.

Aspergillus fumigatus Epidural Abscess and Postsurgical Wound Infection in an Immunocompetent Host

“…A. fumigatus is ubiquitous in the environment and commonly transmitted through conidial inhalation. Pasqualloto et al reported 25 cases of aspergillosis due to neurosurgery, and Panicker et al described 5 others due to combined ear, nose, and throat and neurosurgical procedures [ 5 , 13 ]. In addition to the inhalational route, the central nervous system (CNS) may also be a destination from hematogenous dissemination or directly spread from nasal or paranasal deposits.…”

Letter: Risk of Bone Wax Migration During Retrosigmoid Craniotomy for Microvascular Decompression: Case-Control Study

“…10,11 This aligns with the observation that Staphylococcus Aureus is a predominant pathogen in bone wax-related infections. 10,12 Different fungal infections have also been reported. 12 It is hypothesized that the malleable bone wax is manipulated by the surgeon later in surgery, when the probability of contamination is higher.…”

“…10,12 Different fungal infections have also been reported. 12 It is hypothesized that the malleable bone wax is manipulated by the surgeon later in surgery, when the probability of contamination is higher. 10 In addition, the effect of bone wax on inhibiting bone healing and osteogenesis has been consistently demonstrated in various animal and human studies.…”