World Neurosurg
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Case Reports
Shunt-related intracranial abscess caused by Staphylococcus lugdunensis in a hydranencephalic patient.
Staphylococcus lugdunensis is a coagulase-negative staphylococcus with aggressive and rapidly progressive infectious behavior. This organism has emerged as an important pathogen implicated in both community-acquired and nosocomial infections, including meningitis, brain abscess, catheter-related bacteremia, and ventriculoperitoneal shunt infection. ⋯ This case suggests that if Staphylococcus lugdunensis is identified, a virulent and prolonged clinical course with the production of destructive lesions, similar to those with S. aureus, should be expected. A course of antibiotic therapy and aggressive management that may include surgical treatment will be needed.
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To propose that chronic subdural hematoma (CSDH) should be conceived as a sentinel event in elderly patients and offer an analysis of long-term survival after diagnosis. ⋯ The increased mortality rates in patients with CSDHs relative to standardized mortality data corroborate the conception of subdural hematoma as a sentinel health event.
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Case Reports
The transconjunctival transorbital approach: a keyhole approach to the midline anterior skull base.
To report an initial experience with a medial transorbital approach to the midline skull base performed via a transconjunctival incision. ⋯ The transconjunctival medial orbital craniectomy provides a minimally invasive keyhole approach to lesions located anteriorly along the anterior cranial fossa that are in the midline with lateral extension over the orbital roof. Based on our initial experience with this technique, the working space afforded limits complex surgical dissection; this approach is primarily well suited for less extensive pathology.
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Glioblastoma (GB) is rarely found in the cerebellum. Because of its rarity, it is poorly understood if cerebellar GB (CGB) behaves similarly to supratentorial GB. Studies have been limited to case reports and small case series. A better understanding of CGB may help guide treatment strategies. ⋯ CGBs are difficult to analyze using institutional series because of their rarity. This study shows they are clinically different from supratentorial GB. Among patients with CGB, radiation therapy may prolong survival. This may help guide treatment strategies aimed at prolonging survival for patients with these extremely rare lesions.
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During the past decade, endoscopic intraventricular and skull base operations have become widely used for a variety of evolving indications. A global survey of practicing endoscopic neurosurgeons was performed to characterize patterns of usage regarding endoscopy equipment, instrumentation, and the indications for using image-guided surgery systems (IGSs). ⋯ Many variations and permutations for performing intraventricular and skull base endoscopic surgery exist worldwide. Much can be learned by studying the patterns and indications for using various types of equipment and operative adjuncts such as IGSs.