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Peer-reviewedCC BY-NC-ND 4.0Journal of Neurosurgery: Case Lessons

Robust foreign body giant cell reaction after polymethyl methacrylate cranioplasty: illustrative case

  • Maureen Rakovec1,2
  • Steven K. Yarmoska1,2
  • Maureen Scarboro1,2
  • Cara Lomangino1,2
  • Nima Sharifai3
  • Timothy Chryssikos1,2
  • Gary Schwartzbauer1,2
  1. 1Department of Neurosurgery, University of Maryland School of Medicine, Baltimore
  2. 2R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore
  3. 3Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
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Abstract

BACKGROUND: Foreign body giant cell reaction to a cranioplasty implant is a rare complication of this common neurosurgical procedure, and it may cause clinically significant symptoms. Here, the presentation, imaging, management, and pathology of a patient who developed a robust fibroinflammatory reaction to a polymethyl methacrylate (PMMA) cranioplasty implant are reviewed to aid with future timely diagnosis and management of this complication.

OBSERVATIONS: A 38-year-old male who previously underwent decompressive craniectomy after a gunshot wound to the head with subsequent PMMA cranioplasty presented 1 month postoperatively with surgical site swelling and fevers. MRI demonstrated a subgaleal fluid collection and an epidural mass. The patient was initially treated empirically with antibiotics but remained febrile and developed worsening headache. The patient underwent surgical removal of the implant with excision of fibrovascular tissue after interval MRI demonstrated enlargement of the epidural mass. Intraoperative cultures were negative, and pathological evaluation confirmed the diagnosis of fibrovascular granulation tissue with foreign body giant cell reaction. Postoperatively, the patient’s symptoms resolved.

LESSONS: Fibroinflammatory reactions to synthetic cranioplasty materials can mimic surgical site infections, but key imaging, laboratory, and clinical findings can support the diagnosis. Timely treatment with surgical removal of the implant may be curative.

https://thejns.org/doi/10.3171/CASE26817

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Cite

BibTeXRIS
BibTeX
@article{rakovec2026robust,
  title = {{Robust foreign body giant cell reaction after polymethyl methacrylate cranioplasty: illustrative case}},
  author = {Maureen Rakovec and Steven K. Yarmoska and Maureen Scarboro and Cara Lomangino and Nima Sharifai and Timothy Chryssikos and Gary Schwartzbauer},
  journal = {Journal of Neurosurgery: Case Lessons},
  year = {2026},
  month = oct,
  doi = {10.3171/case26817},
  url = {https://doi.org/10.3171/case26817},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Robust foreign body giant cell reaction after polymethyl methacrylate cranioplasty: illustrative case
AU  - Maureen Rakovec
AU  - Steven K. Yarmoska
AU  - Maureen Scarboro
AU  - Cara Lomangino
AU  - Nima Sharifai
AU  - Timothy Chryssikos
AU  - Gary Schwartzbauer
PY  - 2026
DA  - 2026/10/26
JO  - Journal of Neurosurgery: Case Lessons
DO  - 10.3171/case26817
UR  - https://doi.org/10.3171/case26817
AB  - BACKGROUND: Foreign body giant cell reaction to a cranioplasty implant is a rare complication of this common neurosurgical procedure, and it may cause clinically significant symptoms. Here, the presentation, imaging, management, and pathology of a patient who developed a robust fibroinflammatory reaction to a polymethyl methacrylate (PMMA) cranioplasty implant are reviewed to aid with future timely diagnosis and management of this complication.  OBSERVATIONS: A 38-year-old male who previously underwent decompressive craniectomy after a gunshot wound to the head with subsequent PMMA cranioplasty presented 1 month postoperatively with surgical site swelling and fevers. MRI demonstrated a subgaleal fluid collection and an epidural mass. The patient was initially treated empirically with antibiotics but remained febrile and developed worsening headache. The patient underwent surgical removal of the implant with excision of fibrovascular tissue after interval MRI demonstrated enlargement of the epidural mass. Intraoperative cultures were negative, and pathological evaluation confirmed the diagnosis of fibrovascular granulation tissue with foreign body giant cell reaction. Postoperatively, the patient’s symptoms resolved.  LESSONS: Fibroinflammatory reactions to synthetic cranioplasty materials can mimic surgical site infections, but key imaging, laboratory, and clinical findings can support the diagnosis. Timely treatment with surgical removal of the implant may be curative.  https://thejns.org/doi/10.3171/CASE26817
SN  - 2694-1902
ER  -