World Neurosurg
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Surgical site infection (SSI) is one of the main complications after craniotomy. The incidence is up to 11% in the literature. The established procedure is debridement, removal of the bone flap, and delayed cranioplasty. Delayed cranioplasty has several disadvantages. A promising approach is the immediate titanium mesh implantation at the time of wound revision. We report our experience with this technique regarding outcome measured by reinfection rates and patient satisfaction. ⋯ Our small series seems to confirm that immediate titanium mesh implantation for patients with postcraniotomy SSI is a cost-effective, safe, and cosmetically suitable alternative to delayed cranioplasty in selected patients without hydrocephalus or persistent cerebrospinal fluid fistula.
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Case Reports
Is First Line Vancomycin still the Best Option to Treat Staphylococcus healthcare-associated Meningitis?
Cerebrospinal fluid (CSF) penetration of vancomycin through the blood-brain barrier is poor but important inflammation improved it. Hence, vancomycin is recommended for the treatment of community meningitis. However, what about mild inflammatory health care-associated meningitis? The aim of this study was to evaluate the impact of vancomycin diffusion on CSF in Staphylococcus epidermidis health care-associated meningitis. ⋯ We propose to reassess vancomycin use as first-line therapy when meningeal inflammation is mild-to-moderate in favor of antibiotics, which have a better CSF penetration.
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Case Reports
Successful treatment of refractory status epilepticus using anterior thalamic nuclei deep brain stimulation.
Refractory status epilepticus (RSE) is considered a medical emergency in neurology and is related to high mortality. We report a successfully treated case of RSE using deep brain stimulation (DBS) at the anterior thalamic nuclei (ATN) in a 17-year-old woman. ⋯ DBS at the ATN significantly improved both the electroencephalography and clinical presentation in the patient with RSE. DBS at the ATN should be considered as a possible treatment choice once a patient develops RSE.
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Case Reports
Percutaneous endoscopic removal of a lumbar epidural angiolipoma via interlaminar approach: a technical report.
Although percutaneous endoscopic technique has been routinely used in the treatment of disk herniation, there are few reports on its application in the management of intraspinal tumors. We present a case report of lumbar epidural angiolipoma that was totally removed by percutaneous endoscopic technique. ⋯ This report supports the application of percutaneous endoscopic technique in the surgical resection of noninfiltrating extradural lumbar angiolipoma.
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To study the craniovertebral junction and determine the anatomic characteristics of occipitalization of the atlas (OC) by computed tomography (CT) imaging. ⋯ The outlet of the foramen magnum is severely impaired in patients with OC, and the presence of other osseous anomalies is common. Deformity is not confined to the region of the assimilated atlas; the clivus and odontoid process are also shorter than normal. The lateral facet inclination likely influences disease progression.