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BMJ Case Reports Jan 2024A man in his 30s, with sinonasal undifferentiated carcinoma status post resection 6 years prior, presented with acute onset of fever, headache and altered mentation. The...
A man in his 30s, with sinonasal undifferentiated carcinoma status post resection 6 years prior, presented with acute onset of fever, headache and altered mentation. The patient was diagnosed with bacteremia and meningitis due to A standard antibiotic and corticosteroid regimen was started. Brain MRI showed an encephalocele abutting the superolateral nasopharynx mucosa. After several days of clinical improvement, the patient's mental status and headache acutely relapsed. A CT head venogram showed a large volume pneumocephalus originating from the region of a surgical defect. Management included external ventricular drain placement followed by right pterional craniotomy with skull base packing. Skull base defects increase the risk of life-threatening conditions such as bacterial meningitis and pneumocephalus. It is crucial for clinicians to be aware of the possibility of cranial surgical defects developing years after surgery.
Topics: Male; Humans; Pneumocephalus; Meningitis, Bacterial; Skull Base; Anti-Bacterial Agents; Headache
PubMed: 38238161
DOI: 10.1136/bcr-2023-256194 -
Korean Journal of Neurotrauma Dec 2023Few cases of injuries caused by wild boars have been reported in the literature. Here, we present the case of a 64-year-old male patient who was attacked by a wild boar....
Few cases of injuries caused by wild boars have been reported in the literature. Here, we present the case of a 64-year-old male patient who was attacked by a wild boar. The patient had a laceration to the right forehead and a penetrating wound in the area before the right auricle. Computed tomography scan revealed traumatic subarachnoid hemorrhage, subdural hemorrhage, right temporal lobe contusion hemorrhage, pneumocephalus, right zygomatic arch and temporal bone fracture, and right coronal process fracture of the mandible. Prophylactically, 2,000 mg of ceftriaxone and 400 mg of moxifloxacin were intravenously administered every 24 hours. An emergency craniectomy was performed because the skull fracture was an open fracture and control of the increased intracranial pressure was necessary. Inactivated Rabies Virus Vaccine was also administered postoperatively. We concluded that, unlike typical wounds from other traumatic causes, the risk of wound infection is higher. In order to reduce morbidity and mortality due to wild boar attacks, rapid stabilization of the patient's vital signs, prevention of infection with appropriate antibiotics, and surgical intervention at the appropriate time and method are necessary.
PubMed: 38222830
DOI: 10.13004/kjnt.2023.19.e59 -
World Journal of Critical Care Medicine Dec 2023Pneumorrhachis (PR) is defined as presence of free air in the spinal canal. Traumatic PR is very rare, and its exact incidence and pathogenesis is unknown. A... (Review)
Review
Pneumorrhachis (PR) is defined as presence of free air in the spinal canal. Traumatic PR is very rare, and its exact incidence and pathogenesis is unknown. A comprehensive literature search was performed using the PubMed, Cochrane Library, Google Scholar and Scopus databases to identify articles relevant to traumatic PR published till January 2023. A total of 34 resources were selected for inclusion in this narrative review. Traumatic PR can be classified anatomically into epidural and intradural types. In the epidural type, air is present peripherally in the spinal canal and the patients are usually asymptomatic. In contrast, in intradural PR, air is seen centrally in the spinal canal and patients present with neurological symptoms, and it is a marker of severe trauma. It is frequently associated with traumatic pneumocephalus, skull fractures or thoracic spine fracture. Computed tomography (CT) is considered to be the diagnostic modality of choice. Epidural PR is self-limited and patients are generally managed conservatively. Patients with neurological symptoms or persistent air in spinal canal require further evaluation for a potential source of air leak, with a need for surgical intervention. Differentiation between epidural and intradural PR is important, because the latter is an indication of severe underlying injury. CT imaging of the entire spine must be performed to look for extension of air, as well as to identify concomitant skull, torso or spinal injuries Most patients are asymptomatic and are managed conservatively, but a few may develop neurological symptoms that need further evaluation and management.
PubMed: 38188452
DOI: 10.5492/wjccm.v12.i5.248 -
Neurosurgical Review Jan 2024Pneumocephalus is the pathologic collection of air in the intracranial cavity. In sufficient volumes, it can contribute to symptoms ranging from headaches to death. For... (Review)
Review
Pneumocephalus is the pathologic collection of air in the intracranial cavity. In sufficient volumes, it can contribute to symptoms ranging from headaches to death. For conservative treatment, oxygen use is commonplace. Although this is an accepted tenet of clinical practice, it is not necessarily founded on robust trials. An electronic search of databases EMBASE and MEDLINE and the Cochrane Library was undertaken as per the 2020 Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) statement. Three articles were included. Although the modes of oxygen delivery were heterogenous (non-rebreather versus endotracheal versus hyperbaric chamber), all studies concluded favorably on the use of oxygen therapy for increased reabsorption of pneumocephalus.
Topics: Humans; Pneumocephalus; Headache; Oxygen
PubMed: 38172487
DOI: 10.1007/s10143-023-02261-4 -
Frontiers in Neurology 2023This study sought to characterize postoperative day one MRI findings in deep brain stimulation (DBS) patients.
OBJECTIVE
This study sought to characterize postoperative day one MRI findings in deep brain stimulation (DBS) patients.
METHODS
DBS patients were identified by CPT and had their reviewed by a trained neuroradiologist and neurosurgeon blinded to MR sequence and patient information. The radiographic abnormalities of interest were track microhemorrhage, pneumocephalus, hematomas, and edema, and the occurrence of these findings in compare the detection of these complications between T1/T2 gradient-echo (GRE) and T1/T2 fluid-attenuated inversion recovery (FLAIR) magnetic resonance (MR) sequences was compared. The presence, size, and association of susceptibility artifact with other radiographic abnormalities was also described. Lastly, the association of multiple microelectrode cannula passes with each radiographic finding was evaluated. investigation evaluated hemisphere-specific associations. Multiple logistic regression with Bonferroni correction (corrected = 0.006) was used for all analysis.
RESULTS
Out of 198 DBS patients reviewed, 115 (58%) patients showed entry microhemorrhage; 77 (39%) track microhemorrhage; 44 (22%) edema; 69 (35%) pneumocephalus; and 12 (6%) intracranial hematoma. T2 GRE was better for detecting microhemorrhage (OR = 14.82, < 0.0001 for entry site and OR = 4.03, < 0.0001 for track) and pneumocephalus (OR = 11.86, < 0.0001), while T2 FLAIR was better at detecting edema (OR = 123.6, < 0.0001). The relatively common findings of microhemorrhage and edema were best visualized by T2 GRE and T2 FLAIR sequences, respectively. More passes intraoperatively was associated with detection of ipsilateral track microhemorrhage (OR = 7.151, < 0.0001 left; OR = 8.953, < 0.0001 right). Susceptibility artifact surrounding electrodes possibly interfered with further detection of ipsilateral edema (OR = 4.323, = 0.0025 left hemisphere only).
DISCUSSION
Day one postoperative magnetic resonance imaging (MRI) for DBS patients can be used to detect numerous radiographic abnormalities not identifiable on a computed tomographic (CT) scan. For this cohort, multiple stimulating cannula passes intraoperatively was associated with increased microhemorrhage along the electrode track. Further studies should be performed to evaluate the clinical relevance of these observations.
PubMed: 38169752
DOI: 10.3389/fneur.2023.1253241 -
World Neurosurgery Apr 2024Chronic subdural hematoma (CSDH) is a neurosurgical pathology of an aged populace. Pathogenetic risk factors include traumatic brain injury, prolonged use of...
BACKGROUND
Chronic subdural hematoma (CSDH) is a neurosurgical pathology of an aged populace. Pathogenetic risk factors include traumatic brain injury, prolonged use of antiplatelet drugs, hypertension, and some inflammatory processes. The incidence increases as patients age. Burr-hole evacuation is the most common approach in management of symptomatic cases. We compared evacuation of chronic subdural hematomas with general or local anesthesia (GA and LA, respectively) and evaluated the safety, economic benefits, effects of comorbidity, benefits, and shortcomings of both techniques.
METHODS
We conducted a retrospective study of 67 consecutive patients who had 74 procedures for CSDH in a single neurosurgical center, the Regional Clinic, Centre of Neurosurgery and Neurology, over a 3-year period. They were grouped into the GA group (n = 44) and LA group (n = 23). Mean duration of procedure, length of hospital stay, complications, and preoperative and postoperative neurologic statuses were compared. The distribution of nominal variables between groups was compared using the Fisher exact test. The average duration of operation and length of hospital stay were compared using the Mann-Whitney U-test due to violation of the normality assumption.
RESULTS
LA proved to be as effective as GA in CSDH evacuation. Seventy-four surgical procedures were performed on 67 patients due to recurrence in less than 30 days in 7 patients. Fifteen patients had tension pneumocephalus managed with fluid therapy to full recovery. LA was economical and required shorter hospital stays and surgical time.
CONCLUSIONS
In our studies, LA proved to be noninferior to GA, time conserving, and less prone to some of the adverse effects of GA on elderly patients with comorbidity, although some patients who are hyperactive or contraindicated to LA will require GA.
Topics: Aged; Humans; Retrospective Studies; Hematoma, Subdural, Chronic; Trephining; Neurosurgical Procedures; Anesthesia, General; Drainage; Treatment Outcome
PubMed: 38154679
DOI: 10.1016/j.wneu.2023.12.116 -
Journal of Clinical Medicine Dec 2023Previous studies have revealed the existence of electrode displacement during subthalamic nucleus deep brain stimulation (STN-DBS). However, the effect of electrode...
BACKGROUND
Previous studies have revealed the existence of electrode displacement during subthalamic nucleus deep brain stimulation (STN-DBS). However, the effect of electrode displacement on treatment outcomes is still unclear. In this study, we aimed to analyze the related factors of electrode displacement and assess postoperative electrode displacement in relation to the motor outcomes of STN-DBS.
METHODS
A total of 88 patients aged 62.73 ± 6.35 years (55 males and 33 females) with Parkinson's disease undergoing STN-DBS, with comprehensive clinical characterization before and 1 month after surgery, were involved retrospectively and divided into a cross-incision group and cannula puncture group according to different dura opening methods. The electrode displacement, unilateral pneumocephalus volume percent (uPVP), and brain volume percent were estimated.
RESULTS
A significant anterior and lateral electrode displacement was observed among all implanted electrodes after pneumocephalus absorption ( < 0.0001). The degree of electrode displacement was positively correlated with the uPVP ( = 0.005) and smaller in females than males ( = 0.0384). Electrode displacement was negatively correlated with motor improvement following STN-DBS in both on-medication and off-medication conditions ( < 0.05). Dural puncture reduced the uPVP ( < 0.0001) and postoperative electrode displacement ( = 0.0086) compared with dural incision.
CONCLUSIONS
Electrode displacement had a negative impact on the therapeutic efficacy of STN-DBS. Opening the dura via cannula puncture is recommended to increase the accuracy of the lead implantation.
PubMed: 38137630
DOI: 10.3390/jcm12247561 -
Acta Anaesthesiologica Scandinavica Apr 2024Patients suffering from major traumatic injuries frequently require emergency anaesthesia. Due to often compromised physiology and the time-sensitive management, trauma...
BACKGROUND
Patients suffering from major traumatic injuries frequently require emergency anaesthesia. Due to often compromised physiology and the time-sensitive management, trauma patients may be more prone to desaturate during induction of anaesthesia. We hypothesised that pre-oxygenation using high-flow nasal oxygen would decrease the risk of desaturation during induction of anaesthesia in trauma patients and the study therefore aimed to compare the frequency of desaturation when pre-oxygenation was performed with high-flow nasal oxygen or a traditional facemask.
METHODS
This exploratory, prospective, before-and-after study was conducted at the Karolinska University Hospital, Sweden. Adult (≥18 years of age) patients suffering major traumatic injuries needing emergency anaesthesia were included around the clock. Patients were pre-oxygenated using a tight-fitting facemask during the first nine months of enrollment. High-flow nasal oxygen was then introduced as a method for pre-oxygenation of trauma patients. The primary outcome was the proportion of patients desaturating <93% during induction of anaesthesia, assessed from the start of pre-oxygenation until one minute after intubation. Secondary outcomes included perceived difficulty of pre-oxygenation among anaesthetists (assessed on a scale between 1 and 10) and safety outcomes, such as incidence of regurgitations and intracranial gas (assessed radiologically).
RESULTS
Data from 96 patients were analysed. Facemask pre-oxygenation was performed in 66 patients, while 30 patients were pre-oxygenated with high-flow nasal oxygen. The most frequent trauma mechanisms were stabbing injuries (n = 34 (35%)) and fall injuries (n = 21 (22%)). There were no differences in patient characteristics between the groups. Eight (12%) versus three (10%) patients desaturated <93% in the facemask and high-flow nasal oxygen group respectively, OR 0.81 (95% CI 0.20-3.28), p = .76. Anaesthetists assessed pre-oxygenation using high-flow nasal oxygen as easier compared to facemask pre-oxygenation. No patient in any group showed signs of regurgitation. Among patients with facial or skull fractures requiring anaesthesia before radiology was performed, intracranial gas was seen in four (40%) patients pre-oxygenated with a facemask and in no patient pre-oxygenated with HFNO (p = .23).
CONCLUSION
In this prospective study investigating trauma patients undergoing emergency anaesthesia, we could not see any difference in the number of patients desaturating when pre-oxygenation was performed with high-flow nasal oxygen compared to a tight-fitting facemask. Pre-oxygenation using high-flow nasal oxygen was assessed as easier compared to facemask pre-oxygenation.
Topics: Adult; Humans; Oxygen; Prospective Studies; Masks; Pneumocephalus; Administration, Intranasal; Anesthesia; Oxygen Inhalation Therapy
PubMed: 38129931
DOI: 10.1111/aas.14368 -
Zhonghua Yi Xue Za Zhi Dec 2023To investigate the surgical efficacy of neurosurgery robot deep brain stimulation(DBS) in the treatment of elderly Parkinson's disease(PD). The clinical data of...
To investigate the surgical efficacy of neurosurgery robot deep brain stimulation(DBS) in the treatment of elderly Parkinson's disease(PD). The clinical data of elderly patients (≥75 years) with PD who underwent neurosurgical robot-assisted DBS surgery in the Department of Neurosurgery of the General Hospital of Northern Theater Command from September 2016 to September 2022 were collected retrospectively. Operation time, electrode implantation duration, postoperative pneumocephalus volume, electrode implantation accuracy, the Tao's DBS surgery scale, perioperative complications were analyzed.The unified Parkinson's disease rating scales (UPDRS), UPDRS-Ⅲ, tremor, rigidity, bradykinesia, axial, Barthel Activities of Daily Living (ADL-Barthel), Levodopa Equivalent Daily Dose (LEDD), Montreal Cognitive Assessment (MoCA), Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) scores and mortality were assessed respectively before operation, 6, 12 and 24 months after operation and last follow-up. A total of 25 elderly patients were enrolled, including 14 males and 11 females, aged(78.3±3.2) years. Nine patients had underlying diseases. Nine patients (36%) underwent bilateral Globus Pallidus pars Interna deep brain stimulation (GPi-DBS) and 16 patients (64%) underwent bilateral subthalamic nucleus deep brain stimulation (STN-DBS).The operation time was (1.56±0.19) hours, the electrode implantation duration was (1.01±0.19) hours, the pneumocephalus volume was 9.8(4.7, 23.3) cm, and the electrode implantation accuracy was (0.84±0.24) mm, the Tao's DBS surgery scale was (80.2±6.2).The follow-up time [(, )] was 57.3(27.9, 75.7) months. No serious complications such as intracranial hemorrhage, infection or poor wound healing occurred during the perioperative period. The improvement rate of UPDRS, UPDRS-Ⅲ, rigidity, bradykinesia, and LEDD at 6 months after surgery was significantly higher than that at 24 months after surgery and at the last follow-up (all <0.05); the improvement rate of axial symptoms, ADL-Barthel score, and MoCA score at 6 months after surgery was significantly higher than that at the last follow-up (<0.05). HAMD and HAMA scores showed no significant improvement during follow-up after surgery (both >0.05). At the last follow-up, 12 patients died, with death time of (35.1±20.2) months after operation, and the death age of [(, )] 80(79, 83)years. Robot-assisted DBS surgery for elderly patients with PD is accurate and safe, and the postoperative symptoms are significantly improved, and they can benefit from neuromodulation for long term, and the risks are controllable.
Topics: Aged; Male; Female; Humans; Parkinson Disease; Robotics; Retrospective Studies; Activities of Daily Living; Hypokinesia; Pneumocephalus; Treatment Outcome; Deep Brain Stimulation; Levodopa
PubMed: 38123222
DOI: 10.3760/cma.j.cn112137-20231006-00642