Primary Interhemispheric Subdural Empyemas - A report of three cases and review of literature
Posted by on Saturday, 8th September 2012
Abstract:
Interhemispheric subdural empyema is an uncommon condition and is considered neurosurgical emergency. These are generally seen following neglected oto-rhinological infection, but may be post traumatic or iatrogenic in origin. The source of infection can be frequently found, but in few cases no source of infection can be identified, called primary empyemas. These primary interhemispheric subdural empyemas are even rare. They can present with a rapid progression of symptoms and can carry poor prognosis. Early intervention with craniotomy and appropriate antibiotics can improve the condition of these patients.
We present three cases of primary interhemispheric empyemas who underwent emergency craniotomy and evacuation followed by antibiotics for 6 weeks. All the patients had excellent recovery on mean follow up of 10 years.
Key words:
Interhemispheric subdural empyema, neurosurgical emergency, primary empyemas, craniotomy
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Management of pediatric colloid cysts of anterior third ventricle-A review of 5 cases
Posted by on Saturday, 8th September 2012
Colloid cysts are congenital benign lesions, associated with more aggressive clinical and radiological picture in children than in adults. We present our experience in management of five pediatric patients with colloid cyst of the anterior third ventricle. They have an excellent chance of surgical cure, or they can be devastating and even fatal, if not recognized on time and treated.
Material and methods:
Five pediatric patients (aged 16 years or less) who were surgically treated for a colloid cyst, between 1987 and 2011 were analyzed. The clinical features included raised intracranial pressure in all five cases, of which one patient was brought unconscious with decerebrate posturing. Computed Tomography (CT) scan of the brain was done in all patients. The density of the lesion, enhancement with contrast and the presence of hydrocephalus were analyzed. Four patients underwent a detailed postoperative neurological assessment.
Results:
Three patients underwent the transcallosal-transforaminal approach and total excision of the lesion. One patient underwent revision of the pre-existing ventriculoperitoneal shunt. One patient who was brought in an unconscious state, an external ventricular drain was inserted and she was ventilated. She died four hours after the admission. On follow up, none of the three patients who underwent the transcallosal-transforaminal approach had disconnection syndromes or behavioral disturbances.
Conclusion:
Colloid cysts in children are rarer and more aggressive than their adult counterparts. It is surgically curable. Early detection and total excision of the lesion is a permanent cure with minimum morbidity, when compared to the natural history of the disease. The limited anterior callosotomy does not result in disconnection syndromes or behavioral disturbance.
Key words: Colloid cyst, pediatric, transcallosal-transforaminal, anterior third ventricle, disconnection syndrome.
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multiple burhole surgery as a treament for moyamoya disease
Posted by on Saturday, 8th September 2012
Objective: To re-emphasize that indirect revascularization surgery alone, where multiple burr holes and arachnoid openings are made over both cerebral hemispheres, is beneficial in the treatment of moyamoya disease in children.
Clinical presentation:
We report a 10 year old boy presenting with complaints of episodic headache for the last five years. At the peak of his headache he had visual disturbances and acute onset weakness of left sided limbs, recovering within a few minutes. He had no focal neurological deficits. Radiological investigations revealed abnormal findings, demonstrating the features of moyamoya disease.
Surgical management:
He underwent bilateral multiple burr holes, dural and arachnoid opening over the frontal, parietal and temporal regions of each hemisphere. The elevated periosteal flap was placed in contact with the exposed brain through each burr hole.
Results:
On six months follow up he had only one episode of TIA. Post operative four vessel angiogram demonstrated excellent cerebral revascularization around the burr hole sites, and SPECT imaging showed hypoperfusion in the right temporo-occipital area suggestive of an old infarct with no other perfusion defect in the rest of the brain parenchyma.
Conclusion:
In children with moyamoya disease this relatively simple surgical technique is effective and safe, and can be used as the only treatment without supplementary revascularization procedures. This procedure can be done in a single stage, on both sides, and the number of burr holes made over each hemisphere depends on the extent of the disease.
Key words: indirect revascularization, multiple burr holes, moyamoya disease, children.
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