Complications in Acoustic Neuroma Surgery due to Excessive Use of Oxidized Regenerated Cellulose Haemostatic Product: Report of a Case

Objective: To report a case of acoustic neuroma surgery with brain complications due to the excessive use of oxidized regenerated cellulose hemostatic product. Patient: A 55-year-old woman was operated on for left acoustic neuroma through a translabyrinthine approach. The operation was uneventful, except for a venous hemorrhage from the superior petrosal sinus that was controlled with the use of cellulose hemostatic material. Following the operation, the patient was alert with a left facial nerve weakness (HB-II). In the next 48 hours, the patient deteriorated with a reduced level of consciousness and paralysis of both lower limbs and the one upper limb. The patient was intubated. A CT scan revealed the presence of a hematoma surrounded by diffuse edema. Therefore the patient was reoperated on, and most of the cellulose hemostatic material and a limited hematoma were removed with minimal bleeding. The patient gradually regained consciousness during the next 24 hours and was discharged a week later with minor left-sided upper limp weakness and facial nerve paresis (HB III). The motor function recovered completely 1 year after the operation, and the facial nerve paresis remained at the acceptable level of HB III. Conclusions: It seems that the use of cellulose hemostatic material successfully controlled the acute bleeding. However, the brain complications may be attributed to the presence of this material. The fact that the patient recovered immediately after removing the material and the limited hematoma supports this hypothesis.