World Neurosurg
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Postoperative infection is a potentially dramatic consequence in endoscopic endonasal surgery. The aim of this study was to assess the efficacy of our intraoperative antibiotic prophylaxis by analyzing the risk factors of postoperative meningitis in our series. ⋯ All surgical maneuvers to prevent, detect, and quickly repair intra- and postoperative CSF leak are crucial to avoid postoperative meningitis. The proposed prophylaxis protocol is comparable in safety to those recommended in literature as assessed by the low rate of meningitis.
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Injury to cerebral venous sinuses during craniotomy procedures can cause significant blood loss or venous air embolism, potentially leading to serious morbidity or mortality. When iatrogenic sinus injuries occur, it is essential to promptly obtain hemostasis and repair the sinus defect. ⋯ The use of a reflected dural flap for closure of a widely torn sinus proved to be an effective and straightforward sinus repair strategy, with postoperative imaging demonstrating persistent patency of the sinus. The described technique may be a useful addition to any neurosurgeon's armamentarium and should be considered during cases of complex sinus injuries.
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Surgical results regarding MRI-negative epilepsy were presented and related clinical and histopathological parameters were discussed. ⋯ Our results suggest it is worth pursuing resective surgery in adults as well as in children with drug-resistant epilepsy with normal MRI.
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Mini-craniotomy for chronic subdural hematoma (CSDH) is associated with lower rates of recurrence. However, the procedure is performed mostly with the patient under general anesthesia (GA) and therefore frequently requires an intensive care unit (ICU) facility, especially in the elderly population. Because of the unavailability of ICU beds, and to avoid GA, we started to perform this procedure with the patient under local anesthesia (LA). ⋯ Mini-craniotomy for CSDH under LA is an equally effective procedure compared with mini-craniotomy under GA. In addition, it minimizes the risks of GA in the elderly population and obviates the need of a postoperative ICU bed. It also reduces operative time and hospital stay as compared with GA.
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A subset of patients with skull base cerebrospinal fluid (CSF) leaks are found to have elevated intracranial pressure (ICP). In these patients, elevated ICP is thought to contribute to both the pathophysiology of the leak and postoperative leak recurrences. Current strategies for postoperative ICP control include medical therapy and shunting procedures. The aim of this study is to report the use of venous sinus stenting (VSS) in the management of patients with skull base CSF leaks caused by elevated ICP. ⋯ Patients with skull base CSF leaks of unknown etiology should undergo CSF pressure monitoring postoperatively and, if found to be elevated, be treated for intracranial hypertension. In patients unresponsive to, or intolerant of, medical therapy, VSS can provide an alternative option to medical and surgical shunting procedures for treatment of intracranial hypertension in patients with skull base CSF leaks and venous sinus stenosis.