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. (C) 2015 Elsevier Inc. All rights reserved.