World Neurosurg
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Case Reports
Candida meningitis after transphenoidal surgery: a single institution case-series and literature review.
Candida meningitis after neurosurgical procedures is a rare but potentially devastating complication. The presentation of meningitis can be insidious in immunosuppressed patients and thus can be easily overlooked. Cerebrospinal fluid studies often resemble bacterial profiles, and cultures can be falsely negative. ⋯ A high index of suspicion is needed in any patient with risk factors such as abdominal surgery, bowel perforation, recent broad spectrum antibiotic therapy, intravenous drug use, extremes of age, indwelling catheters, and immunosuppression such as AIDS, malignancy, antineoplastic therapy, and steroid use. Here, we describe 3 case presentations of patients with giant skull base tumors who developed postsurgical Candida meningitis, each with vastly different clinical courses and outcomes, ranging from benign to catastrophic. We performed a literature review with special focus on common risk factors, Candida species, diagnostic criteria, and treatment.
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Posterior fossa decompression surgeries for Chiari malformations are susceptible to postoperative complications such as pseudomeningocele, external cerebrospinal fluid (CSF) leak, and meningitis. Various dural substitutes have been used to improve surgical outcomes. ⋯ Dural substitutes generated from porcine collagen, compared with those from bovine collagen, were associated with a higher likelihood of pseudomeningocele development in adult patients undergoing Chiari I malformation decompression and duraplasty.
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We describe a patient who presented with superior quadrianopsia due to an occipital micro AVM that bled into the optic radiation. Onyx embolization was attempted. However, early follow-up angiogram revealed recanalization and recurrence of the AVM. ⋯ The best and definitive treatment for AVMs is either surgical resection or radiosurgery. However, in our institute a small subset of microAVMs might be cured by endovascular embolization in a single session. In the case presented here, a single feeder was demonstrated and microcatheter navigation toward a good working position seemed feasible; thus we decided to try first an endovascular approach.
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Superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis is a common procedure for vascular neurosurgeons, and it is used in a variety of diseases. However, there are cases in which the STA is absent or is too hypoplastic to be used as a donor for revascularization. Occipital artery (OA)-MCA bypass may be a treatment option in these cases. ⋯ OA-MCA bypass may be a surgical option for cerebral revascularization when the STA is not available.
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To evaluate the safety of irreversible electroporation (IRE) on the sciatic nerve after IRE ablation of adjacent tumor. ⋯ The nerves adjacent to the tumor may undergo severe damage after IRE ablation, but their function and structure can return to normal in a short time. IRE ablation may be a feasible treatment option for tumors situated adjacent to nerves.