Extradural Abscess Research Articles

Extradural infections of the spine.

We have observed a recent increase in the incidence of spinal extradural infections. To determine postoperative outcome and prognosis we have undertaken a retrospective study on patients with spinal extradural abscesses between 1978 and 1996 treated in the Department of Neurosurgery at the Nordstadt Hospital in Hannover, Germany. Case records, outpatient files, operation notes, neuroradiological examinations and pathological reports were analysed. Neurological function was documented using a score system for each symptom. Twenty-two patients underwent 24 operations during the study period. Staphylococcus aureus was the organism most commonly isolated. Patients presented after a mean history of 1.8+/-2.6 months with acute development of severe para- or tetraparesis and were followed up for an average period of 6+/-7 months. Two groups were distinguished. One group was characterized by epidural collections of pus (14 patients). Two patients in this group were not operated due to their moribund state and died from uncontrollable septicemia. Two of the remaining 12 operated patients died within 30 days after surgery due to generalized septicemia or other medical problems unrelated to the spinal involvement. Of the ten surviving patients, five sustained major neurological deficits, whereas the remaining five patients made an incomplete recovery. The second group consisted of eight patients in a significantly better pre-operative health condition in whom granulomatous material was obtained during the operation and the outcome was considerably better. No patient in this group died. Six patients recovered with no or mild neurological deficits. Spinal extradural infections require immediate surgical intervention. Neurological outcome depends on the pre-operative neurological status. Survival is determined by the general health condition of the patient.

鼻性頭蓋内合併症の2症例

Two cases of rhinogenic spontaneous intracranial complications are reported. One case was a 10 year-old female, the other was a 53 year-old male. The primary lesion was located in either the frontal or sphenoidal sinus with respect to complications, brain and extradural abscesses were noted.Intracranial complications arising from nasal infections are very serious, but these two cases were treated successfully with surgical drainage. A CT scan was useful for both the early detection and for facilitating the treatment of the intracranial lesions.The intracranial complications arising from sinusitis continue to be present in different forms because antibiotic therapy can mask the real conditions.

Extradural frontal abscess complicating nasal septal abscess in a child

Nasal septal abscess (NSA) is an uncommon sequel to minor nasal trauma. Abscess extension beyond the nasal cavity is rarely documented. A case of a 10-year-old boy who presented with a NSA associated with a large extradural frontal abscess is presented and indications for CT scanning in the workup of pediatric patients with NSA is discussed.

Epidural abscess after epidural analgesia treated successfully with antibiotics

Spinal extradural abscess is an infrequent, but serious complication to extradural catheters. Early diagnosis is essential for successful treatment. An extradural abscess may develop slowly over days to several weeks and symptoms may be vague and unspecific, delaying correct diagnosis. Meticulous supervision of the patients is required and must continue as long as an epidural catheter is in place and for some time after the catheter has been withdrawn. This case report describes a patient undergoing extensive reconstructive plastic surgery after a leg trauma. For postoperative pain treatment a continuous epidural infusion of bupivacaine was given. After 10-14 days an extradural abscess developed with increasing low back pain but without any neurologic symptoms. With antibiotics a complete resolution of the extradural abscess occurred, documented by computerized tomography (CT).

Conservative Management of Extradural Abscess Complicating Spinal-Extradural Anesthesia for Caesarean Section

Conservative Management of Extradural Abscess Complicating Spinal-Extradural Anesthesia for Caesarean Section

Successful Meropenem Therapy of a Brain Abscess and Meningitis Arising From Acute Purulent Otomastoiditis: Case Report

We describe a case of a 25-year-old female with an acute left otomastoiditis, accompanied by a left temporal extradural abscess with moderate perifocal edema and meningitis. Intravenous meropenem (2 g 8-hourly) and intravenous methylprednisolone (40 mg once daily) were commenced empirically. Teicoplanin (400 mg once daily intravenously) was added after 5 days when culture results were available. Teicoplanin was discontinued on day 25 but meropenem and methylprednisolone were continued for a further 15 days, after which the abscess completely resolved without sequelae. No treatment-induced adverse effects or seizures were observed. Thus, in selected patients, antibacterials (in conjunction with a corticosteroid) may be successfully used without surgery to treat brain abscesses and in such circumstances meropenem is a useful option for empiric therapy.

Pin-site complications of the halo thoracic brace with routine pin re-tightening.

Retrospective analysis with historic controls. To analyze pin-site complications in a large series of halo thoracic braces in which regular re-tightening of the pins was performed. Perry and Nickel first described the use of the halo thoracic brace in 1959 for cervical immobilization. Its use has been extended successfully to cervical fracture management. A total of 266 commercially available halo thoracic braces were fitted using a standard technique. All pins were tightened routinely at 24 hours and at 1 week after application. Two data sources, prosthetic department records and patients' medical records, were analyzed. Six percent of patients had a pin-site infection; 3.7% had loose pins, and 1.1% reported pin-site pain. No subdural, intradural, or extradural abscess or cerebrospinal fluid leaks occurred. A total of 2.6% of halo rings slipped off, and 2.3% of patients experienced severe headaches. Low rates of pin-site infection, loosening, and pain were achieved through routine re-tightening of the pins. Pin re-tightening, at 24 hours and at 1 week after application, is a safe and effective method to decrease pin-site complications.

2-41-05 Diffuse meningitis and extradural abscess as the most frequent otogenic intracranial inflammatory complications

2-41-05 Diffuse meningitis and extradural abscess as the most frequent otogenic intracranial inflammatory complications

Lumbovertebral syndrome after repeat extradural blood patch.

We describe an obstetric patient who developed incapacitating headache after inadvertent dural tap and was treated with repeated blood patching. She subsequently developed severe lumbar back pain which, after exclusion of suspected extradural abscess, was treated successfully with simple analgesics and physiotherapy. Two possible explanations are offered to account for her symptoms. We compare this case with others in the literature.

血管柄付き肋骨移植を用いた胸腰椎前方固定術の経験

We performed vascularized rib grafts for anterior fusion of the thoracolumbar spine in 3 cases. Case 1: A 23-year-old female with an extradural abscess at the Th3-6 level. A 5cm vascularized graft obtained from the 6th rib was used for fusion from Th3 to Th6. Radiographically, bony fusion was observed two months after operation. Case 2: A51-year-old female with spinal tuberculosis at the Th7-11 level. A 7cm vascularized graft obtained from the 8th rib was used for fusion from Th7 to Th12. Radiographically, bony fusion was observed three months after the operation. Case 3: A50-year-old male with spinal tuberculosis at the Th9-L5 level. A 15cm vascularized graft obtained from the 9th rib was used for fusion from Th9 to L4. Although bony fusion was not observed at three months after the operation, correction of kyphosis was maintained. Vascularized rib grafts appear to be an easy method for anterior fusind of thoracolumbar spine and a useful treatment for cases with destruction involving multiple vertebral bodies and marked kyphosis.

Ｂｅｚｏｌｄ濃ようを合併した慢性中耳炎例

A 30-year-old man was admitted to the Shiga Univ. of Medical Science for pyrexia, right otorrhea and right lateral neck swelling. He had not consulted a doctor despite his right otorrhea of 1 year's duration. He was diagnosed as having on extradural abscess and Bezold's abscess caused by chronic otitis media. He was treated with a mastoidectomy, trepanation and antibiotic therapy. Post operatively, he was asymptomatic.

William Macewen and the treatment of brain abscesses: revisited after one hundred years

The year 1993 marked the centennial of the publication of Sir William Macewen's monograph, Pyogenic Infective Diseases of the Brain and Spinal Cord, and its accompanying volume, Atlas of Head Sections. As Harvey Cushing noted, the text on pyogenic diseases of the brain was a landmark in surgery of the nervous system. At the time of its publication, Macewen's work was the most comprehensive study of pyogenic brain diseases. In this paper the author reviews the state of knowledge of brain abscess existing in the 19th and 20th centuries, with particular emphasis on the late 19th century, and elucidates factors contributing to Macewen's remarkable success. His thorough knowledge of the natural history of pyogenic diseases of the temporal bone and nasal sinuses, in addition to his clear description of cranial anatomy, as illustrated in his Atlas of Head Sections, were especially important in developing his successful treatment of brain abscess. The x-ray had not yet been discovered; Macewen's diagnosis was based on clinical findings superbly illustrated by his three clinical stages of brain abscess development. His clinical observations are as relevant today as when he described them 100 years ago. Macewen recorded 25 cases of brain abscess. Nineteen of these patients came to his attention in time to undergo surgery, resulting in 18 recoveries. All five of his patients with extradural abscess recovered. These results were achieved in the era known as "the most glorious period in British surgery." Neurosurgery was in its infancy; nevertheless, even as the 20th century closes, Macewen's results still have not been surpassed.

Medical-surgical treatment of progressive tuberculous (Pott's) paraplegia in Gabon.

The present study deals with the results of the medical-surgical treatment of 22 patients with Pott's tetraplegia or paraplegia. Seventeen had progressive tetraplegia-paraplegia which failed to respond solely to medical treatment. On admission, four patients exhibited an acute onset tetraplegia-paraplegia, and one had a 'spinal tumour syndrome'. In addition to antituberculous therapy, seven patients had anterior spinal surgery, consisting of four corporectomies, two anterior debridments and grafting, and one debridment alone. Moreover, one patient had a posterior interbody fusion, four had laminotomies, and 10 had laminectomies. The causes of the spinal cord or cauda equina compression, as was determined at operation, were extradural abscess in eight patients, bony compressions in 11, arachnoiditis in two, and posterior neural arch tuberculosis in one patient. Neurological recovery began between 10 and 21 days postoperatively. The mean length of follow-up was 42.36 months (range 8-144 months). Fourteen patients were found to be functionally and neurologically normal at follow-up examinations (63%). Eighty-two percent recovered sufficiently to walk unaided. Two patients were left paralysed and unable to walk. Two patients were able to get about on crutches. The onset of objective improvement soon after surgical decompression suggests a causal effect. It was concluded that early neural decompression and spinal stabilisation provided the maximum potential for neurological recovery.

Indications for the surgical management of central nervous system blastomycosis

BACKGROUNDBlastomycotic infections of the central nervous system (CNS) occur infrequently. The medical literature concerning blastomycosis of the CNS contains little information regarding indications for surgery.METHODSWe report five cases of CNS blastomycosis that required surgery: four intracranial and one intraspinal. One patient had a prior diagnosis of sarcoidosis, whereas none of the others had been diagnosed with any other systemic illness. The patients were evaluated with plain x rays as well as with computed tomography or magnetic resonance imaging.RESULTSFour of these patients had extradural abscesses that required surgical drainage as well as debridement of granulomatous tissue and infected bone. The remaining patient had an intracerebellar abscess. Postoperatively, three patients were treated with amphotericin B, one with amphotericin B and ketoconazole, and one with an experimental protocol of fluconazole alone. All of the patients recovered without sequelae of seizures, recurrence of disease, or reaction to pharmacotherapy, although one patient had transient renal insufficiency due to amphotericin B.CONCLUSIONSOur experience with CNS blastomycosis managed surgically is reported. We propose three general surgical indications for these patients: mass lesions, diagnostic biopsy, and osteomyelitis refractory to pharmacotherapy.

Cervical extradural abscess complicating discitis and associated disc prolapse, secondary to a long line infection.

Cervical extradural abscess complicating discitis and associated disc prolapse, secondary to a long line infection.

両側Ｇｒａｄｅｎｉｇｏ症候群例

Gradenigo's syndrome was diagnosed in a 5-year-old male with bilateral acute otitis media, paralysis of both abducens nerves and bilateral irritation of the trigeminal nerves. After myringotomy and administration of antibiotics, his tympanic membrance became normal, and the bilateral trigeminal nerve irritation disappeared, but residual mastoiditis was revealed by X-ray examination. Right extended mastoidectomy was performed including removal of the bony sinus plate on Mar. 2, 1990. Although bilateral abducens palsy improved immediately, serological findings and double vision deteriorated again 10 days after the operation. Reexploration was done on Mar. 16, 1990. Residual inflammatory changes in the petrous apex were eradicated, especially around the lateral sinus and anterior to the superior semicircular canal through the petrous apex. An extradural abscess was found at the petrous apex. The left trigeminal nerve irritation and the left abducens paralysis was attributed to the right petrositis because bilateral abducens nerve function recovered completely after the second operation on the right temporal bone. Since extradural abscess at the petrous apex is difficult to diagnose preoperatively and has been reported in many patients with Gradenigo's syndrome, it must be kept in mind in the diagnosis and the treatment of Gradenigo's syndrome. Twelve cases of Gradenigo's syndrome reported in Japan from 1960 to 1992 were reviewed. Acute otitis media was the cause in five, all children. In three of them abducens paralysis appeared within one week after onset of the acute otitis media. Mortality of Gradenigo's syndrome is still 10%, similar to that of brain abscess associated with otitis media.

Role of Bone Graft in Reconstruction of Skull Base Defect: Is a Bone Graft Necessary

Ten patients underwent reconstruction of skull base defects between 1989 and 1992. In this series, the maximum size of the skull base defect was 6 x 5 cm. Three patients underwent bone grafts to reinforce the skull base. The postoperative course of seven patients without bone grafts was uneventful. There was no cerebrospinal fluid leakage, meningitis, extradural abscess, on brain herniation. On the other hand, two of the three patients with bone grafts developed extradural abseesses requiring the bone grafts to be removed. Although the number of patients in this series is not large, this study demonstrates that the use of bone grafts in reconstruction of skull base detects could be one of the factors in increasing the chances of infectious complications. We think that a bone graft is not necessary to reconstruct moderate-sized skull base defects.

SPINAL EXTRADURAL ABSCESS: PURSUIT OF VIGILANCE

A case of delayed extradural abscess and quadriplegia after extradural steroids is presented. Nine other cases of extradural abscess from the literature are reviewed to illustrate the influence of continuity of hospital admission and informed surveillance on successful outcome when extradural infection arises after extradural medication. A Medic-Alert system is proposed as a means of improving vigilance and neurological outcome for patients at risk. Careful study of the cost-effectiveness of such a scheme is recommended.

硬膜外膿瘍をきたした小児中耳真珠腫の一症例

A case of otogenic extradural abscess due to cholesteatoma is reported. A 9-year-old boy was diagnosed with chronic otitis media and underwent medical treatment.He complained of left otalgia, ear discharge and headache. CT scan provided the most reliable information for diagnosis, and revealed the presence of an extradural abscess. He was treated by mastoidectomy and craniotomy. He was subsequently treated by staged tympanoplasty and good auditory acuity was secured.

Duro-cutaneous fistula caused by a ‘congenital’ cholesteatoma

A cervical fistula from a 'congenital' cholesteatoma is described in a 70-year-old man. This was found to communicate with an extradural temporal lobe abscess. The presentation and management is described. No previous report of such a case has been found in a review of the literature.