{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:23:51Z","timestamp":1787239431991,"version":"build-2736575974"},"reference-count":23,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2010,10]]},"abstract":"\n Object<\/jats:title>\n Microfibrillar collagen hemostat (MCH; trade name Avitene) is a partially water-insoluble acid salt of purified bovine corium collagen. This agent has been widely used to control hemorrhage at surgery, and especially during pediatric neurosurgeries at the authors' institution. Despite its effectiveness, rare case reports detailing adverse inflammatory reactions to MCH have been documented. Based primarily on MR imaging, postoperative reactions have most commonly elicited clinical differential diagnoses of tumor recurrence or abscess. According to the literature, MCH induces a very characteristic mixed inflammatory response that is rich in eosinophils; in light of these observations, many authors have suggested an allergy-based pathogenesis.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n The authors retrospectively reviewed 3 pediatric neurosurgical cases treated at their institution, wherein a common histomorphological inflammatory reaction to MCH was elicited at the site of prior craniotomy.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Case 1 is that of a 10-year-old girl whose diagnosis was a right temporal lobe ganglioglioma, classified as WHO Grade I. Case 2 is that of a 9-year-old boy whose diagnosis was a left parietal lobe anaplastic ependymoma, classified as WHO Grade III. Finally, Case 3 is that of a 15-year-old girl whose diagnosis was focal cortical dysplasia Type IIA affecting the left occipital lobe. Each patient presented with new or recurrent seizures 5\u20136 weeks after the initial resection. The postsurgical reactions incited by MCH mimicked the radiological appearance of either an abscess (Cases 2 and 3) or recurrent tumor (Case 1). Histologically, the mixed inflammatory infiltrate was typified by the presence of MCH-centric necrotizing granulomas that were surrounded by a palisade of macrophages and often several eosinophils.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The findings are in keeping with previous case reports describing the clinicopathological features of adverse reactions occurring due to MCH. Based on the authors' observations, the possibility of an idiopathic inflammatory reaction to MCH should be considered when either seizures, a typical radiological appearance (that is, consistent with tumor recurrence or abscess formation), or both arise shortly after initial surgery. A conservative treatment approach to this type of inflammatory lesion appears to be the most appropriate management strategy.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2010.8.peds10248","type":"journal-article","created":{"date-parts":[[2010,10,1]],"date-time":"2010-10-01T09:58:35Z","timestamp":1285927115000},"page":"385-392","source":"Crossref","is-referenced-by-count":21,"title":["Microfibrillar collagen hemostat\u2013induced necrotizing granulomatous inflammation developing after craniotomy: a pediatric case series"],"prefix":"10.3171","volume":"6","author":[{"given":"Liat","family":"Apel-Sarid","sequence":"first","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Division of Anatomic Pathology;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doug D.","family":"Cochrane","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Pediatric Neurosurgery; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Steinbok","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Pediatric Neurosurgery; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela T.","family":"Byrne","sequence":"additional","affiliation":[{"name":"Department of Radiology, Children's and Women's Health Centre of British Columbia, University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Dunham","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Division of Anatomic Pathology;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0060385","series-title":"Am J Ophthalmol","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1016\/S0002-9394(14)70194-1","article-title":"Orbital Avitene granuloma formation after enucleation for intraocular retinoblastoma","volume":"123","author":"Abramson","year":"1997"},{"key":"b2-0060385","series-title":"Med Lett Drugs Ther","first-page":"28","article-title":"Avitene: a new topical hemostatic agent","volume":"19","author":"Anonymous","year":"1977"},{"key":"b3-0060385","series-title":"Skeletal Radiol","doi-asserted-by":"publisher","first-page":"953","DOI":"10.1007\/s00256-006-0090-8","article-title":"Radiculopathy due to microfibrillar collagen hemostat mimicking recurrence of disc herniation","volume":"35","author":"Doita","year":"2006"},{"key":"b4-0060385","series-title":"Neurosurg Clin N Am","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1016\/S1042-3680(18)30655-7","article-title":"Iatrogenic intracerebral hemorrhage","volume":"3","author":"Gibbons","year":"1992"},{"key":"b5-0060385","series-title":"No Shinkei Geka","first-page":"1067","article-title":"[Peculiar computed tomographic images after intracranial use of microfibrillar collagen hemostat: report of three cases.]","volume":"17","author":"Gondo","year":"1989"},{"key":"b6-0060385","series-title":"No Shinkei Geka","first-page":"1313","article-title":"[Experimental study on brain tissue of microfibrillar collagen hemostat (Avitene).]","volume":"14","author":"Hashimoto","year":"1986"},{"key":"b7-0060385","series-title":"Thromb Res","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1016\/0049-3848(86)90269-0","article-title":"Hemostatic effects of microfibrillar collagen hemostat (MCH) in experimental coagulopathy model and its mechanism of hemostasis","volume":"42","author":"Hatsuoka","year":"1986"},{"key":"b8-0060385","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"503","DOI":"10.3171\/jns.2002.97.3.0503","article-title":"Reduction of transfusion rates in the surgical correction of sagittal synostosis","volume":"97","author":"Hentschel","year":"2002"},{"key":"b9-0060385","series-title":"J Thorac Cardiovasc Surg","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1016\/S0022-5223(94)70167-9","article-title":"Use of microfibrillar collagen hemostat (Avitene) and thrombin to achieve hemostasis after median sternotomy","volume":"108","author":"Hill","year":"1994"},{"key":"b10-0060385","series-title":"Surg Today","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1007\/BF00311821","article-title":"How safe are the xenogeneic hemostats? 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