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

Abstract

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. 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. A case report. Two cases of delayed cauda equina compression complicating the closure, with BSAG, of small unintentional tears in the dura requiring lumbar decompressive surgery. They included postoperative CT and MRI findings. We compared postoperative imaging and perioperative findings during subsequent surgery. 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. 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.