World Neurosurg
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In view of the few large prospective studies available on the role of preoperative diffusion tensor imaging (DTI), and the potential of DTI in showing the relationship between tumor and white matter tracts, we studied the role of preoperative DTI in planning a safe surgical corridor, predicting the neurologic and surgical outcome and tumor characterization in supratentorial intra-axial brain tumors. ⋯ Preoperative DTI is a landmark tool for planning a safe surgical corridor and predicting the tumor type along with neurologic and surgical outcome of patients.
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To compare outcomes of scoliosis correction with direct vertebral rotation (DVR) and without DVR (no direct vertebral rotation [N-DVR]) through meta-analysis. ⋯ This meta-analysis showed that postoperative thoracic Cobb angle, postoperative lumbar Cobb angle, and postoperative apical vertebral rotation were better with DVR compared with N-DVR. Further large multicenter studies will be necessary to substantiate these results.
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Primary orbital involvement is extremely rare in echinococcosis. We report a case of giant orbital hydatid cyst in a 15-year-old boy. ⋯ Hydatic cyst should be kept in differential diagnosis of orbital cystic lesions, especially in pediatric population and endemic areas.
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Arachnoid cysts are common anomalies in the intracranial region. However, an intraventricular arachnoid cyst is rare, and occurrence within the fourth ventricle is especially uncommon; only 16 cases have been described in the literature. Arachnoid cysts in the fourth ventricle may cause obstructive hydrocephalus or cerebellar ataxia or cranial nerve palsy. Treatment of a fourth ventricular arachnoid cyst is complete or partial resection via a midline suboccipital approach. Recently, endoscopic fenestration has become the procedure of choice in the treatment of arachnoid cysts in supratentorial locations, but as yet there has been no report of treating a fourth ventricle arachnoid cyst using a flexible endoscope. ⋯ As per our knowledge, this is the first case reporting the treatment of an arachnoid cyst of the fourth ventricle using a flexible endoscope via the anterior horn of the lateral ventricle. This method can be used to treat arachnoid cysts of the fourth ventricle.
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The rate of ventriculoperitoneal (VP) shunt infection is reported between 3% and 20%. Vancomycin-resistant enterococci (VRE) are increasingly prevalent nosocomial pathogens worldwide, and they rarely cause infections to the central nervous system. Daptomycin is a cyclic lipopeptide effective antibiotic because of its rapid bactericidal effect. It is a life-saving treatment option for meningitis, bacteremia, sepsis, endocarditis, and urinary system infections caused by VRE. ⋯ The patient was admitted to the medical center with umbilical discharge, and shunt revision was applied with the thought of shunt dysfunction. Intermittent umbilical cerebrospinal fluid (CSF) leakage continued, and the patient experienced a fever 2 weeks after the operation. VRE growth in his CSF culture was treated by meropenem and linezolid. Upon continuation of the growth afterwards, the patient was referred to our hospital and underwent extraventricular drainage, and IV linezolid, IV daptomycin (8 mg/kg per day), and IVT daptomycin (2.5 mg/kg per day) was scheduled as treatment. On the fifth day of treatment, there was no growth in the culture, and no side effects were observed during the treatment. A VP shunt was placed in the patient for the 15 days of IV daptomycin plus IVT treatment, and 36 days of linezolid. No infection was observed in the 8-month follow-up period.