World Neurosurg
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Optic neuritis (ON) is unilateral painful optic nerve inflammation in a young healthy female diagnosed by excluding glaucoma. ON onset during pregnancy is rare, with only 2 cases reported to date. ⋯ Associated pituitary macroadenoma complicated the true diagnosis of ON, because contrast medium cannot be used in pregnant women. The diffusion-weighted MRI findings were useful for diagnosing this complex clinical condition.
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Cerebrospinal fluid (CSF) culture is the gold standard for diagnosing postoperative central nervous system infection. The time to positivity (TTP) of an automated continuous blood culture system may indicate the original concentration of the organism. Coagulase-negative Staphylococcus (CoNS), the common organism recovered in CSF, poses difficulty in differentiating infection from contamination. This study investigated the TTP of CSF culture with CoNS and its relationship to clinical parameters and prognosis. ⋯ Targeted antibiotic therapy was more likely to be beneficial to patients with a rapid TTP within 7 days, which suggested that CoNS with a rapid TTP represents the pathogen of central nervous system infection rather than contamination in neurosurgical patients.
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Medulloblastoma (MDB) is an aggressive embryonal brain tumor, with underlying altered genetics and biological pathways that account for very heterogeneous natural histories and clinical behaviors. Positron emission tomography (PET) using radiolabeled amino acids provides important metabolic information for the diagnosis of cerebral glioma but only a few data are available on amino acid PET in MDB. In particular, no cases of MDB imaging with 6-[(18)F]-fluoro-L-3,4-dihydroxyphenylalanine (F-DOPA) have previously been described. ⋯ The 2 cases reported here suggest that sensitivity of F-DOPA PET in MDB can be low. However, more comprehensive data are needed to conclude on the overall accuracy of F-DOPA PET in MDB.
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Ventriculitis is a serious infection associated with high mortality even when both intravenous (IV) and intrathecal (IT) antibiotics are administered. Poor outcome in patients with ventriculitis indicates the need to be more aggressive in our attempts to expeditiously eradicate the infection. The purpose of this study was to evaluate the role of endoscopic lavage (EL) in patients with severe purulent ventriculitis, unresponsive to IV and IT antibiotics. ⋯ The addition of IT antibiotics has resulted in improved outcome in patients with ventriculitis; however, some patients continue to be unresponsive to antibiotics. EL can play a complementary role in eradicating such recalcitrant infections. EL should be considered in any patient with ventriculitis, if infection persists even after ∼7-10 days of IVand IT antibiotics.
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The medial opticocarotid recess (MOCR), which contains the lateral tubercular recess (LTR), is an important landmark for the cavernous internal carotid artery (ICA) and for accessing the parasellar and suprasellar regions. These microanatomic landmarks for endoscopic endonasal surgery can be observed using surgical simulation with three-dimensional images. The aim of this study was to analyze the MOCR in patients with pituitary macroadenoma using three-dimensional images. ⋯ Pituitary macroadenomas expand the distance between the left and right MOCR together with the distance between the left and right ICA.