World Neurosurg
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Case Reports
Ventriculoperitoneal shunt infection with Mycobacterium abscessus: a rare cause of ventriculitis.
Mycobacterium abscessus is a rapidly growing atypical mycobacterium implicated in chronic lung disease, otitis media, surgical site infections, and disseminated cutaneous diseases. It is typically seen in patients with some degree of immunosuppression. Only 1 previous case has been reported in the setting of ventriculoperitoneal (VP) shunt infection. We report a case of M abscessus as the causative organism in a VP shunt infection in an immunocompetent adult. ⋯ Nontuberculous mycobacteria are rare, atypical organisms in the setting of VP shunt infection. Patients with ventriculitis secondary to atypical mycobacteria may exhibit drug-resistant cerebrospinal fluid pleocytosis in the face of standard antibiotic regimens.
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The potential for radiation exposure during neurosurgical training has increased dramatically in the last decade. Incorporation of instrumented and minimally invasive spinal surgery and neuroendovascular procedures into the curriculum has led to increased potential for exposure to ionizing radiation. Contemporary neurosurgery residents' exposure to radiation has not been previously reported. ⋯ To our knowledge, this study is the first to quantify radiation exposure for neurosurgery residents in the current era of training. From this work, efforts may be initiated to increase awareness and safety with regard to radiation exposure. Although the total dose is not high, a better understanding of the impact of radiation exposure on practitioners may help to drive institutional policies to reduce occupational exposure.
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Case Reports
Cerebellar enterogenous cyst with atypical appearance and pathological findings: a case report.
Intracranial enterogenous cysts are rare and occur mainly in the posterior fossa. These cysts are usually extra-axial, midline, anterior to the brainstem, or at the cerebellopontine angle. Intracranial intra-axial enterogenous cysts are extremely rare. We report a case of an intra-axial cerebellar enterogenous cyst in which diagnosis was difficult because the lesion resembled an arachnoid cyst in appearance and showed atypical pathologic findings. ⋯ The diagnosis of enterogenous cyst is based mainly on histologic findings, because characteristic findings on neuroimaging have not been defined. Although total resection of enterogenous cysts is recommended in general, partial resection while ensuring the cyst communicates adequately with the surrounding cerebrospinal fluid space with or without a shunt procedure may be useful if the cyst is adherent to surrounding neurovascular structures.
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Decompressive craniectomy is an established treatment for malignant intracranial hypertension. Cranioplasty is performed once cerebral swelling has resolved. Complications include infection, postoperative fluid collections, hematoma, reoperation, and seizures. Our experience using a double layer technique during craniectomy with a collagen matrix onlay dural substitute and expanded polytetrafluoroethylene for antiadhesive properties during cranioplasty was reviewed. ⋯ Our dual layer closure technique at time of decompressive craniectomy carries a similar reduction in operative time and estimated blood loss when compared with cranioplasty series with other antiadhesives present. The technique described enables easy dissection of the musculocutaneous flap from the dural plane during cranioplasty and increases the safety of the operation.