Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Clinical Trial
Reduction in shunt infection using antibiotic impregnated CSF shunt catheters: an Australian prospective study.
Antibiotic impregnated shunt catheters have emerged as a promising tool against the continuing challenge of shunt infection. We present our prospective evaluation of the efficacy of antibiotic (rifampicin and clindamycin) impregnated cerebrospinal fluid (CSF) shunt catheters (AIC) in a mixed paediatric and adult Australian population. We have prospectively evaluated all the cerebrospinal fluid shunt procedures carried out in our institution over a 3-year period since July 2002, after the introduction of AIC in our practice. ⋯ We also report that the introduction of ceftriaxone prophylaxis during this period was associated with a reduction in Gram-negative shunt infection, but no effect on overall infection rate. We report rifampicin and clindamycin impregnated CSF shunt catheters significantly reduce the rate of shunt infection in Australian clinical practice. This data and the literature support the routine usage of AIC for all CSF shunt procedures.
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Comparative Study
Complications related to positioning in posterior fossa craniectomy.
To compare complications associated with surgical position, a retrospective study was conducted on 260 patients who underwent posterior fossa craniectomy. Data collected from the records included demographic profile, American Society of Anesthesiologists' physical status score, neurological status, cranial nerve involvement, associated medical illnesses, anaesthetic technique, patient position, haemodynamic changes, duration of surgery, venous air embolism (VAE), blood loss/transfusion, postoperative complications, duration of ICU stay, and postoperative neurological status. Statistical analysis was done using the Chi-square test and independent t-tests. ⋯ Most postoperative complications (surgical or otherwise) were comparable between the groups (p>0.05). Most patients in both groups developed mild-to-moderate disability with independent lifestyle at the seventh postoperative day. To conclude, both sitting and horizontal positions can be used safely in posterior fossa surgeries.
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Case Reports
Reactivation of dormant lumbar methicillin-resistant Staphylococcus aureus osteomyelitis after 12 years.
The adequate treatment of methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis has intrigued clinicians for some time. As the resistance of these pathogens, coupled with the increase in community-acquired cases, continues steadily to rise, clinicians are finding it useful to employ multi-modal approaches for efficacious treatment. The authors present a single case report of a patient with recurrent MRSA osteomyelitis, lumbar paraspinal and epidural abscess. ⋯ This case demonstrates the diagnostic and therapeutic dilemmas with which these lesions present. We postulate that the MRSA osteomyelitis/discitis pathogens were walled off in the disc space and subsequently inoculated the soft tissues with ensuing bacteremia. We concur that antimicrobial treatment should be the first line of therapy for these patients; however, surgical debridements and cautious spinal instrumentation should be employed where appropriate.
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We aim to evaluate the mechanisms responsible for complications during trigeminal rhizotomy via foramen ovale puncture. Ten dry skulls and 10 skull-base specimens were investigated in the present study. In cadaveric skull-base specimens, the anatomical relationships between the foramen ovale, mandibular nerve and Gasserian ganglion and the surrounding neurovascular structures were investigated intradurally. ⋯ The abducent nerve, adjacent to the anterior tail of the petrolingual ligament, was observed passing along the lateral wall of the cavernous sinus. Advancement of the catheter more than 10 mm from the foramen ovale is likely to damage the internal carotid artery and the abducent nerve at the medial side of the petrolingual ligament. Thermocoagulation of the lateral wall of the cavernous sinus may damage the cranial nerves by heat, giving rise to pareses.