GAUZE-INDUCED GRANULOMA (GAUZOMA) - AN UNCOMMON COMPLICATION OF GAUZE REINFORCEMENT OF BERRY ANEURYSMS

Incompletely and even adequately clipped berry aneurysms are often reinforced with finely shredded gauze. In seven female patients this practice led to a series of events including headache, pyrexia, seizures, cranial nerve deficits, endocrinopathy, cerebrospinal fluid pleocytosis, and an enhancing mass demonstrated by computerized tomography at the aneurysm site. One patient with blindness, hydrocephalus, and panhypopituitarism died and was examined at autopsy. Three additional female patients have been identified in the literature with similar case histories. It is suggested that in these patients the gauze induced a foreign-body granuloma, accompanied by progressive occlusion of neighboring small arteries. It would seem prudent to reserve gauze reinforcement for aneurysms that cannot be securely obliterated surgically.