Delayed cauda equina compression after spinal dura repair with BioGlue: magnetic resonance imaging and computed tomography aspects of two cases of "glue-oma".

BACKGROUND CONTEXT: Bovine serum albumin and glutaraldehyde (BSAG) (BioGlue) is a surgical adhesive widely used for off-label applications in neurosurgical procedures to minimize the risk of cerebrospinal fluid leakage after dural closure.

PURPOSE: To describe magnetic resonance imaging (MRI) and computed tomography (CT) aspects of two cases of postoperative BSAG expansion causing delayed cauda equina compression requiring further surgery.

STUDY

DESIGN

A case report.

PATIENT SAMPLE: Two cases of delayed cauda equina compression complicating the closure, with BSAG, of small unintentional tears in the dura requiring lumbar decompressive surgery.

OUTCOME MEASURES: They included postoperative CT and MRI findings.

METHODS

We compared postoperative imaging and perioperative findings during subsequent surgery.

RESULTS

In both cases, imaging showed cauda equina compression due to epidural masses found during subsequent surgery comprising BioGlue. These masses appeared slightly hyperdense on CT scans and markedly hypointense on T2-weighted MRI scans.

CONCLUSIONS

When applied as a thick layer during use as a dural sealant, BSAG may swell, leading to a symptomatic "glue-oma" giving a hypointense image on T2-weighted MRI scans.