Evacuation Of Abscess Research Articles

Is the antibiotic prophylaxis useful in closed head injury? Infection of a closed cerebral hematoma

We report an unusual case of a 55-year-old diabetic female who was initially managed conservatively for left temporal hematoma due to nonpenetrating head injury. 6 weeks after discharge she was brought to the emergency department with history of fever, headache, vomiting and altered sensorium of 2 days duration. A diagnosis of left temporal abscess was made on computed tomography scan. She improved after burr-hole evacuation of abscess and administration of appropriate antibiotics. She was not found to have any septic focus in body on investigations. Literature of pathogenesis of abscess developing over the intracerebral hematoma has been briefly reviewed. This case opens the debate for antibiotic prophylaxis in diabetic patients with cerebral hematoma due to closed head injury.

La maladie de Grisel treated by combined C1-2 transarticular and C1 lateral mass screw fixation

The authors describe a novel posterior approach to atlantoaxial stabilization combining C1-2 transarticular and C1 lateral mass screws with vertical connecting rods to create a strong construct with four-point fixation. They present here a case of atlanto-axial instability secondary to infection, Grisel's syndrome, necessitating instrumented stabilization after a period of close clinical and radiological observation following the initial cervical decompression and evacuation of retropharyngeal and epidural abscesses.

Cerebral abscess in pregnancy: a clinical dilemma

A 19-year-old at 39 weeks gestation had caesarean delivery for pathological cardiotocograph at 2 cm cervical dilatation. Antenatal, intrapartum and postpartum blood pressures did not exceed 140/90 mm Hg. On...

Transcervical drainage of epidural and retropharyngeal abscess

This report describes treatment of concurrent epidural and retropharyngeal abscesses and presents a novel surgical approach to treating this pathology. The treatment of epidural and retropharyngeal prevertebral abscesses requires surgical drainage in addition to systemic antibiotics. After the patient’s airway is secured, urgent otolaryngologic surgery consultation is obtained for transoral drainage of the retropharyngeal abscesses to minimize risk to vascular and nervous structures within the neck. If epidural extension is also present, urgent neurosurgical evaluation and decompression may be necessary. We report a patient with an epidural and prevertebral abscess. A posterior approach was taken for wide decompression of the cervical spine and evacuation of the epidural collection. During this procedure, under fluoroscopic guidance, an 8 Fr soft rubber catheter was slowly advanced ventrally in the epidural space through the C5–6 intervertebral disk into the retropharyngeal abscess with evacuation of this collection as well. Using a single, wide posterior approach, the dorsal epidural, the ventral epidural, and prevertebral abscesses were all successfully evacuated. This report describes a novel approach for evacuation of prevertebral abscess concurrent with multilevel laminectomy for epidural abscess evacuation.

Orbital Foreign Bodies: Expect the Unexpected

Data of three pediatric patients with orbitofacial trauma were reviewed. Two patients presented with recurrent orbital inflammation with partial remission with antibiotics. One patient presented with diplopia. All patients underwent full opthalmic examination and computed tomography (CT) of the brain and orbit, followed by surgical intervention. The indication for surgery was either abscess evacuation, repair of blowout fracture, or mass excision. All of the patients had intraorbital wood foreign bodies that were not evident on CT and were not suspected from the history given by the parents. All were surgically removed. One patient had multiple wood foreign bodies (more than 10). Chronic or recurrent orbital inflammation, unexplained proptosis, or orbital masses following orbitofacial trauma in children should raise the suspicion of intraorbital foreign bodies even if not detected by CT studies. Presence of other sequelae of trauma such as blowout fracture does not exclude the possibility of associated foreign bodies.

Hymen care for unmarried Muslim females: role of the forensic consultant in gynaecology interventions

This case series illustrates the role of the forensic consultant in hymen care for unmarried Muslim females exposed to gynaecology interventions. The age range of the 12 females attending University of Jordan Hospital in Amman was 35 days to 28 years. Gynaecology interventions included the use of a vaginoscope, circular resection of the hymen in cases of congenital imperforate hymen, evacuation of perineal abscess and evaluation of a torn hymen. The forensic consultant provides a valuable role in reassuring patients and parents about procedures used to avoid rupturing the hymen, and in protecting the gynaecologist's and patients' rights by providing reports of the status of the hymen before and after intervention in cases where damage is unavoidable.

Preoperative and Postoperative Intracranial Complications of Acute Mastoiditis

We determined the clinical characteristics and treatment outcomes of an unusual cluster of intracranial complications seen in acute mastoiditis (AM). We performed a retrospective review of pediatric patients treated for AM in a tertiary care hospital from March 2006 to March 2007. Eleven children, 6 months to 10 years of age (mean age, 3.8 years), were treated for AM confirmed by computed tomography, which identified asymptomatic intracranial complications in 8 of the 11 patients: these were sigmoid sinus thrombosis (4 patients), epidural abscess (4), perisigmoid abscess or bony erosion (2), and tegmen mastoideum dehiscence (1). All patients required operative intervention with tympanomastoidectomy, although only 2 patients required neurosurgical intervention, consisting of evacuation of epidural abscess and sigmoid sinus thrombosis, respectively. Cultures yielded routine organisms and 1 multidrug-resistant strain of Streptococcus pneumoniae. One patient developed reaccumulation of the subperiosteal abscess that required revision mastoidectomy, and another patient developed postoperative sigmoid sinus thrombosis. Although uncommon, intracranial complications of AM may present without clinical signs or symptoms. Computed tomography of the temporal bone with contrast is essential for identifying asymptomatic complications. Mastoidectomy remains the mainstay of surgical treatment. Neurosurgical intervention and anticoagulation may be avoided with protracted postoperative intravenous antibiotics. Postoperative vigilance is crucial, as complications may evolve despite aggressive therapy.

Surgical treatment of cerebral abscess with the use of a mobile ultralow-field MRI

Surgical intervention in cerebral abscess is indicated to confirm diagnosis, to identify pathogens for specific antibiotic therapy, or to reduce mass effect. Regarding long-term outcome, freehand or stereotactic aspiration are equally efficient compared to surgical resection. However, direct observation of relief of mass effect is not possible by either method. Six patients presenting with neurological symptoms and laboratory signs of infection and diagnosed with an intra-axial cystic lesion underwent frameless stereotactic aspiration of a cerebral abscess in our institution with the use of a mobile intraoperative magnetic resonance imaging (MRI) with a field strength of 0.15 T. Images were acquired before and during the procedure and used for neuronavigation. In all six cases, complete evacuation of the abscess with collapse of the cyst could be achieved and documented intraoperatively. No complications were observed. All patients showed clinical improvement postoperatively. We highlight the advantages of using a mobile intraoperative MRI unit with an illustrative case of a patient who had already undergone abscess evacuation without alleviation of symptoms before using intraoperative MRI. Finally, we discuss surgical treatment options of cerebral abscesses.

Multiple brain abscesses due to Actinomyces species

We report a case of multiple brain abscesses due to Actinomyces species in a 35-year-old immunocompetent man who presented with a 2-month history of headache, diplopia, fever, and weight loss. Despite receipt of broad-spectrum antibiotics for over a month, he continued to have headaches and diplopia. He subsequently underwent right anterior temporal lobectomy and evacuation of abscesses. The diagnosis was aided by identification of sulfur granule on histopathological examination of cerebral cavitary lesion and Gram-positive filamentous rods seen on tissue-Gram stain.

Combined thoracoscopic and endoscopic management of mid-esophageal benign lesions: use of the prone patient position

Both benign tumors and mid-esophageal diverticula are rare conditions; underlying disorders may be present in case of diverticula. Traditionally, thoracotomy was the preferred route to approach these lesions. Now, more surgeons are using minimally invasive techniques to treat these benign mid-esophageal lesions. A total of 12 patients with symptomatic mid-esophageal lesions were studied, benign tumors were seven cases and five cases of diverticula. We present our experiences with thoracoscopic enucleation of benign tumors and diverticulectomy aided by peroperative endoscopy. All the patients were placed in the prone position and approached via a right thoracotomy. Two patients had minor complications of pneumonitis and dysphagia, which were treated conservatively. One patient had a leak from the staple line that needed a second-look thoracoscopy and evacuation of abscess. In this study, we highlight the use of the prone patient position, the advantages of a right thoracoscopic approach and the value of peroperative endoscopy. The prone position was first described in 1994, but has not been popular. Peroperative endoscopy accurately localizes diverticula and determines level of stapler application. Thoracoscopy has definite benefits regarding reduced morbidity. The combined modality of peroperative endoscopy is useful in diverticulectomy. Based on our experience, we believe the prone patient position is the ideal position for esophageal surgery.

Successful Sonographically Guided Drainage of Epidural Abscess

WEB This is a Web exclusive article. pidural abscesses are most commonly found in the older pediatric age group (12–16 years) and adults; they are relatively rare in younger children [1]. Epidural abscesses are almost always secondary to or associated with other infections such as mastoiditis, sinusitis, postoperative infection, osteomyelitis of the skull, or complications of trauma or surgery [2, 3]. Traditional management of epidural abscesses in children involves neurosurgical drainage and antibiotic therapy [3, 4]. Techniques for neurosurgical drainage include evacuation of the epidural collection through a burr hole or a craniotomy [3]. Given the availability of more powerful antibiotics, the trend toward using less invasive alternatives for evacuation of epidural abscesses [3] has grown. In that light, we report on the percutaneous drainage of an intracranial epidural abscess using sonography guidance in a 15year-old boy.

A case of intracranial abscess due to Brucella melitensis

A case of intracranial abscess due to Brucella melitensis

Surgical Procedure Skills of Graduating Medical Students: Effects of Sex, Working, and Research Experience

Background. Surgical procedures constitute an important part of every physician's daily practice. However, few studies have investigated the surgical skills of graduating medical students and, especially, factors that might be related to their degree of surgical competence. The present study sought to gather information on the basic surgical skills of graduating medical students and to establish whether factors influencing the students' competence could be identified and used to improve the teaching of basic surgical skills at medical schools.Methods. A questionnaire was sent to all final-year medical students in Finland in 1997. It was returned by 404 (participation rate 80.2%) students. The questionnaire included questions on the theoretical knowledge and successful performance of 10 basic surgical procedures: abdominal paracentesis, application of Sengstake–Blakemoore tube, rubber-band ligation of hemorrhoids, reposition and casting of Colles' fracture, knee arthrocentesis, application of tibial traction, evacuation of subcutaneous abscess, male bladder catheterization, suprapubic catheterization, and nevus excision.Results. Over 90% of the final-year medical students knew the theory of performing reposition and casting of Colles' fracture, knee arthrocentesis, urinary tract catheterization, and nevus excision, but only 32% (124/393) knew the theory of applying the Sengstake–Blakemoore tube. Nevus excision had been successfully performed by over 90% of the students. Of the emergency or duty procedures, application of the Sengstake–Blakemoore tube and abdominal paracentesis had been successfully performed by 1% (4/393) and 8% (32/393) of the students, respectively, whereas Colles' fracture reposition and suprapubic catheterization had been successfully performed by 46% of the students (182/393 and 179/393, respectively). The age-adjusted odds ratios for performing Colles' fracture reposition (OR 1.59; 95% CI 1.01 to 2.50), application of tibial traction (2.00; 1.03 to 3.89), evacuation of subcutaneous abscess (2.13; 1.25 to 3.62), and suprapubic catheterization (2.23; 1.21 to 4.09) were significantly higher among males than females. Students with working experience had higher odds ratios for performing suprapubic catheterization (OR 6.75; 95% CI 1.99 to 22.84), nevus excision (5.69; 2.49 to 13.0), reposition and casting of Colles' fracture (1.72; 1.01 to 2.94), knee arthrocentesis (4.78; 2.67 to 8.53), and evacuation of subcutaneous abscess (12.9; 6.12 to 27.1) than students without such experience. Students who had done extracurricular research had significantly lower odds ratios for performing evacuation of subcutaneous abscess (0.58; 0.34 to 0.99) than students without such experience. When the five medical faculties in Finland were compared, the highest odds ratios for performing procedures were at the university in which a student logbook was systematically used.Conclusions. Final-year medical students have fairly good theoretical knowledge of basic surgical procedures, but the successful performance rates of these procedures range from 1 to 90%. Males have performed surgical procedures significantly more often than females. Working experience clearly enhanced the surgical skills of medical students. However, research experience may impair the learning of these procedures. The systematic use of logbooks seems to be useful.

Ultrasound-based navigation during intracranial burr hole procedures: experience in a series of 100 cases

BACKGROUND To establish a rational basis for intraoperative ultrasound guidance in neurosurgical procedures via a single burr hole approach based on the experience of one hundred cases. METHODS The single burr hole approach is carried out using a bayonet-shaped ultrasound transducer with a tip dimension of 8 × 8 mm. The ultrasound probe with a mounted puncture adapter fits a standard burr hole and allows real-time imaging of the ongoing surgical steps. RESULTS One hundred cases with five indications have been operated on so far: tapping of the ventricular system (46 patients), tapping of intracranial cysts (23 patients), biopsy of intracranial tumors (15 patients), evacuation of intracranial abscesses (9 patients), and evacuation of intracerebral hematomas (7 patients). Depending on their size, the ventricles could be clearly visualized in 34 of 46 patients. In the remaining patients the free margin of the falx served as orientation. Two ventricles could neither be visualized nor entered. Visualization and puncture of intracranial cysts were easy to achieve throughout, as was the case with abscesses. Tumor biopsy was unsuccessful in two patients harboring lymphomas at distances of more than 50 mm from probe to target. Intracerebral hematomas were easily visualized but, due to the presence of clots, aspiration was impossible in two patients. One patient with a giant glioblastoma died the day after the uneventful biopsy due to increased cerebral edema. No other complications occurred. CONCLUSIONS The presented method of ultrasound-based neuronavigation is an easy-to-use, fast, and safe technique of real-time imaging for free-hand single burr hole procedures.

Neuroendoscopic techniques in treatment of intracranial lesions

SummaryThe Marburg experience of a decade of intracranial neuroendoscopy is presented. Various endoscope systems and auxiliary instruments which were used over this period are discussed and the results of the basic anatomical research is described. During 1988–1997 more than 400 neuroendoscopic interventions were performed to treat intracranial pathologies. The main indications were: stereotactic endoscopic biopsies for unclarified space-occupying lesions, third ventriculostomy in the treatment of occlusive hydrocephalus; endoscopic interventions on ventricular shunts; fenestration and evacuation of intracranial cysts; evacuation of intracerebral haematoma and brain abscesses; and endoscopic evacuation of septated chronic subdural haematoma. The overall operative morbidity rate was around 2% and the mortality rate < 1%. Neuroendoscopy is now an established minimal invasive technology for the operative treatment of well-circumscribed intracranial pathologies.

Endoscopy in neurosurgery

SummaryThis paper, based upon the authors' 5 years of personal experience and an extensive review of published work, reviews the advances in instrumentation, neuroimaging and surgical techniques that have led to the rediscovery and development of neuroendoscopy. The operative techniques employed have a steep learning curve and require special training. Data is now accumulating from established centres in Australia, France, America and the UK that justify the application of neuroendoscopic approaches to an increasing number of neurosurgical conditions. Although the most frequent use is in connection with hydrocephalus and the complications of implanted CSF diversionary devices, neuroendoscopy now has a part to play in biopsy and resection of intraventricular and paraventricular tumours; drainage of non-tumoral cysts; evacuation of intraparenchymal haematomas and abscesses; and, in conjunction with open microneurosurgical procedures, for cerebral aneurysms and lesions on the skull base. Neuroendoscopy has a particular role in paediatric neurosurgery. The overall incidence of significant complications is < 10% in experienced hands. Further advances await the development of real-time neuronavigation and studies which compare the results of neuroendoscopic surgery with those achieved using other techniques.

P-4-521 - Stereotactic evacuation of intracerebral abscess

P-4-521 - Stereotactic evacuation of intracerebral abscess

Endoscopic stereotaxy--an eight year's experience.

During the 10th meeting of the WSSFN in Maebashi in 1989, we discussed 'endoscopic stereotaxy', and presented our preliminary results. This technique was first designed to optimize stereotactic biopsy, but it proved to be effective for other neurosurgical indications as well, including endoscopic stereotactic evacuation of intraparenchymal and intraventricular space-occupying cysts, endoscopic stereotactic cystoventriculostomy, third ventriculostomy, evacuation of brain abscess and intracerebral hematoma, and retrieval of adherent or free-floating ventricular catheters. Our results with endoscopic stereotaxy in different indications are encouraging, compared to conventional microsurgical techniques and pure stereotactic techniques. From 1989 to 1997 we have performed more than 400 stereotactic endoscopic procedures. The mortality rate is below 1%, the operative morbidity is below 3%.

Microbiology and Antimicrobial Therapy of Spinal Infections

Hematogenous vertebral osteomyelitis is almost always a monomicrobial infection affecting predominantly the older population. S. aureus is the most common micro-organism isolated. Gram-negative bacilli, however, are seen primarily in elderly males with the urinary tract as the source of infection, as well as in IVDA. In the latter group, P. aeruginosa, as well as S. aureus, are the dominant microorganisms. The offending organisms are generally isolated by needle biopsy, using a cutting needle, or by open surgical biopsy when necessary. Spinal epidural abscesses have very similar microbiology. Antimicrobial therapy is generally given parenterally in high doses, together with surgical evacuation of abscesses and debridement of necrotic tissue, when necessary. Therapy may be guided by the ESR. In VO, when the patient is doing clinically well and the ESR decreases to at least half of the pretherapy value, therapy may be stopped, but continued elevation of the ESR and the presence of abscesses may necessitate more prolonged therapy. The role of oral antimicrobial therapy is currently unclear.

Minimally invasive endoscopic neurosurgery--a survey.

In 1989 we introduced "endoscopic stereotaxy" as a new operative procedure into neurosurgery. This technique was first scheduled to optimize stereotactic biopsy. In its further development it proved to be effective for other indications. We choose the term "Minimal Invasive (Endoscopic) Neurosurgery (MIEN)" for these interventions. Minimal invasive endoscopic techniques are applied preferably for diagnostic and therapeutic interventions on preformed or pathological cavities of the central nervous system. The indications are, endoscopic-stereotactic biopsy of space-occupying lesions, ventriculoscopy and endoscopic ventriculostomy in diagnosis and treatment of hydrocephalus, endoscopic evacuation of cystic space occupying lesions, endoscopic evacuation of intracerebral haematoma, endoscopic evacuation of septated chronic subdural haematoma, endoscopic evacuation of subacute or chronic brain abscesses, endocavitary syringostomy. Our results with minimal invasive endoscopic interventions for different indications are encouraging when compared to conventional microsurgical techniques. We have performed more than 300 minimal invasive endoscopic interventions. The mortality rate was below 1%, the operative morbidity was below 2%.