Intracranial Infection Research Articles

Perioperative risks of intracranial infection after duraplasty in Chiari malformation type I

Background and ObjectivesThis study aims to assess the risk factors linked to intracranial infection in individuals with Chiari malformation type I (CM-I) undergoing duraplasty, with the goal of providing insights into the clinical prevention and control of postoperative intracranial infections.MethodsA retrospective analysis was conducted on the clinical records of 168 patients diagnosed with CM-I who underwent duraplasty at the Department of Neurological Surgery in the First Affiliated Hospital of Chongqing Medical University, from May 2014 to May 2024. The patients were divided into two groups based on the presence or absence of intracranial infection, and clinical data for both groups were collected. Univariate and multivariate logistic regression analyses were performed to investigate potential risk factors for developing intracranial infection postoperatively.ResultsOf the 168 patients who underwent surgery, 28 cases (16.67%) were classified as the intracranial infection group, while 140 cases (83.33%) were classified as the non-infection group. Multifactorial logistic regression analysis indicated that preoperative anemia, preoperative hypoalbuminemia, operative time exceeding 3 h, surgical incision length exceeding 5 cm, and cauterization of cerebellar tonsils were independent risk factors that influenced the development of postoperative intracranial infection.ConclusionThe likelihood of developing intracranial infection following duraplasty in patients with CM-I is influenced by various factors. Specifically, anemia (OR 17.09), hypoalbuminemia (OR 17.71), long operative time (OR 10.93), extended surgical incision (OR 173.25), and cauterization of cerebellar tonsils (OR 31.29) were identified as key contributors to postoperative intracranial infections. These findings emphasize the necessity of optimizing patient health status and refining surgical techniques to mitigate infection risks. Implementing targeted clinical prevention strategies that address these factors may reduce the incidence of postoperative intracranial infections and improve overall patient prognosis.

Clinical characterization of diseases associated with anti-N-methyl-D-aspartate receptor encephalitis combined with anti-myelin oligodendrocyte glycoprotein antibodies in adults.

The aim of this study was to analyze the clinical characteristics of adult patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis combined with anti-myelin oligodendrocyte glycoprotein (MOG) antibodies. This was a non-randomized controlled study. Clinical data were collected from 17 patients with anti-NMDAR encephalitis combined with anti-MOG antibodies admitted to Xuanwu Hospital, Capital Medical University, from January 2020 to August 2024. As controls, 20 patients with NMDAR(+)/MOG(-) and 27 patients with MOG(+)/NMDAR(-) were selected. The mean age of onset in the double-positive group was 33.47 ± 1.065years, with a male-to-female ratio of 14:3. Significant differences were observed between the NMDAR(+)/MOG(+) group and the NMDAR(+)/MOG(-) group in terms of headache, lumbar puncture pressure, and cerebrospinal fluid (CSF) leukocyte counts (P < 0.05). Comparing the NMDAR(+)/MOG(+) group with the MOG(+)/NMDAR(-) group revealed significant differences in gender, headache, mental and behavioral abnormalities, limb twitching, loss of consciousness, cognitive impairment, speech impairment, visual impairment, limb numbness, cortical/sub-cortical white matter, brainstem lesions, OB type II, and CSF leukocyte counts (P < 0.05). No statistically significant differences were found in the comparison of CSF and serum antibody titers among the three groups (P > 0.05). NMDAR and MOG antibodies can coexist in patients with autoimmune diseases, with a predominance of young male patients. The double-positive group exhibited more severe intracranial viral infections and a higher rate of intrathecal immunoglobulin synthesis in the central tissues. Compared to the double-positive group, NMDAR encephalitis alone presented with more similar clinical manifestations, while MOG-related disease demonstrated a higher likelihood of brainstem involvement.

Clipping of anterior circulation aneurysms using fully endoscopic-assisted minimally invasive keyhole craniotomy: a clinical study and analysis.

Endoscopy's ability to provide close observation, deep magnification, and multi-angle views has proven to be an effective tool for minimally invasive craniotomy in neurosurgery. However, no large case series have been published on the use of fully endoscopic-assisted minimally invasive keyhole craniotomy for clipping intracranial aneurysms (IAs). To evaluate the value of fully endoscopic-assisted minimally invasive keyhole craniotomy in the treatment of anterior circulation aneurysms. A retrospective analysis was conducted on 20 patients who underwent fully endoscopic-assisted minimally keyhole invasive craniotomy for clipping of IAs. A total of 9 anterior communicating artery (ACoA) aneurysms were clipped using the supraorbital keyhole approach (SKA). Additionally, 10 middle cerebral artery aneurysms (MCA) and 2 posterior communicating artery (PCoA) aneurysms were clipped using the pterional keyhole approach (PKA). The clipping success rate was 100% in all patients. Apart from one patient who experienced transient third cranial nerve palsy, one who developed an intracranial infection, and one who had a brief seizure, no other patients experienced serious complications. Except for one patient who had residual muscle weakness due to a preoperative basal ganglia hemorrhage, all other patients had a modified Rankin Scale (mRS) score of ≤ 1. Fully endoscopic-assisted minimally invasive keyhole craniotomy has promising applications in the treatment of anterior circulation aneurysms in Hunt-Hess grade 0-II, especially for unruptured aneurysms. Future multi-center studies are needed to confirm its broader applicability.

Active Cryptococcus neoformans glucuronoxylomannan production prevents elimination of cryptococcal CNS infection in vivo

BackgroundCryptococcus neoformans (Cn) causes life-threatening meningoencephalitis in individuals with AIDS. Cn’s polysaccharide capsule is mainly composed of glucuronoxylomannan (GXM) and plays a key role in the dysregulation of immunity, resistance to antifungal drugs, and systemic dissemination, including CNS invasion. Although recent studies have begun to elucidate the involvement of microglia in cryptococcosis, our knowledge of these CNS resident phagocytes in the control of cryptococcosis is limited.MethodsWe investigated microglial responses to Cn infection and the effect of active capsular production by comparing wild-type H99 and acapsular mutant cap59 strains using the CX3CR1-EGFP transgenic mouse and a stereotaxic intracerebral infection model.ResultsMicroglia had difficulty combating Cn H99 infection. Active production and secretion of the capsular material altered the morphology and distribution of microglia around cryptococcomas or fungal brain lesions. It also affected the infiltration of peripheral immune cells to CNS fungal infection. Moreover, RNA sequencing analyses supported the importance of capsule production in immune modulation. Chemotaxis assays demonstrated that active capsular production by Cn H99, and especially GXM, impaired microglial motility and fungal phagocytosis.ConclusionOur findings suggest that microglia may not be able to control cryptococcal CNS infection and that active capsular production and release may contribute to the progression and persistence of cerebral cryptococcosis.

Clinical efficacy of surgery for patients with Chiari malformation type I with syringomyelia: posterior fossa decompression versus posterior fossa decompression with resection of tonsils.

The optimal surgical approach for treating Chiari malformation type I (CM-I) with syringomyelia remains a topic of debate. Key areas of controversy include the extent of decompressive craniectomy, the necessity of subarachnoid exploration, and whether to excise the herniated tonsils. In this study, we present our perspectives on these contentious issues through a retrospective analysis of the clinical efficacy of posterior fossa decompression with resection of tonsils (PFDRT) compared to posterior fossa decompression (PFD). We conducted a retrospective analysis of clinical data from 162 patients diagnosed with CM-I and syringomyelia who underwent surgical intervention at the Affiliated Hospital of Xuzhou Medical University between January 2017 and December 2022. Among these, 58 patients underwent PFD, while 104 received PFDRT. The efficacy of the treatments was evaluated using the Chicago Chiari Deformity Prognosis Scale (CCOS) at 6 months post-surgery, with scores ranging from 13 to 16 indicating a favorable prognosis. Furthermore, the improvement of syringomyelia was assessed through magnetic resonance imaging (MRI) at the six-month follow-up. Six months post-surgery, according to the Chiari Clinical Outcome Scale (CCOS) score, the improved rates for the PFD and PFDRT groups were 56.9 and 78.8%, respectively. Additionally, the recovery rates for syringomyelia in these groups were 55.2 and 76%, respectively. Statistically significant differences were observed in both the rates of favorable prognosis and syringomyelic improvement between the two groups (p < 0.05). The incidence of complications, including fever, cerebrospinal fluid leakage, intracranial infection, and incision infection, did not differ significantly between the groups (p > 0.05). Our findings indicate that PFDRT yields superior outcomes in syringomyelia improvement and favorable prognoses compared to PFD, while maintaining comparable postoperative complication rates.

Direct oral anticoagulants versus vitamin K antagonists for cerebral venous thrombosis (DOAC-CVT): an international, prospective, observational cohort study.

Direct oral anticoagulants versus vitamin K antagonists for cerebral venous thrombosis (DOAC-CVT): an international, prospective, observational cohort study.

A children patient with intracranial infection after brain surgery associated with elevated Torque Teno Virus

A children patient with intracranial infection after brain surgery associated with elevated Torque Teno Virus

Imaging of the Hyrtl Fissure: A Rare Cause of Congenital CSF Otorrhea.

Hyrtl fissure is a rare cause of congenital CSF otorrhea in infants, with only a few cases previously described in the English literature. Given the predisposition to repeated ear and intracranial infections, identification of this bony anomaly is critical in the diagnosis and management of recurrent meningitis or otitis media in a child, especially in the presence of CSF otorrhea. We describe 3 cases of this entity with a specific focus on the embryologic basis of the etiology and conventional and advanced imaging features of this unique entity.

Utilization of Artificial Dura for Anterior Skull Base Reconstruction Following Transcranial Resection of Benign Cranionasal Communicating Tumors: Technical Note

Abstract Objective The purpose of this study was to introduce a watertight duraplasty with artificial dural grafts for anterior skull base (ASB) reconstruction. Methods Between November 2019 and October 2023, we used artificial dural grafts for the ASB reconstruction in 10 cases of recurrent benign cranionasal communicating tumors. Through a transcranial subfrontal approach, the tumor was totally removed and the skull base defect was repaired using the NormalGEN® and DuraMax® artificial dural grafts. Clinical and imaging follow-ups were conducted to screen for the occurrence of postoperative cerebrospinal fluid (CSF) leakage, intracranial infection, and encephalocele. Results Gross total resection of tumor and ASB reconstruction with the artificial dural grafts were achieved in 10 patients. The patients were followed up clinically for 11 to 52 months (mean 26.0 months) and underwent medical imaging follow-up for 6 to 36 months (mean 18.4 months). One patient presented with CSF leakage on day 47 after the operation. Another patient endured intracranial infection without CSF leakage on the fifth day after the operation. Both patients were cured. No encephalocele was observed during the follow-up period. All the patients achieved a favorable recovery. Conclusion Following transcranial resection of benign cranionasal communicating tumors, we utilized artificial dural grafts for ASB reconstruction when the frontal pericranium was impaired by tumor invasion or previous surgery. Our initial experience and postoperative follow-up have proven that the method is feasible and reliable in selected cases.

Clinical Manifestations and Neuroimaging Features of Intracranial Infection among Study at a Tertiary Care Hospital in Bangladesh

Clinical Manifestations and Neuroimaging Features of Intracranial Infection among Study at a Tertiary Care Hospital in Bangladesh

Neurocysticercosis presenting as postpartum psychosis: a case report on challenging clinical insight with review of the literature

Neurocysticercosis presenting as postpartum psychosis: a case report on challenging clinical insight with review of the literature

Impact of the COVID-19 pandemic on the incidence of pediatric intracranial empyemas in Spain.

Intracranial infections due to sinusitis and otitis, although rare, can progress rapidly and result in significant morbidity, necessitating multifaceted management including extended antibiotic therapy and surgical intervention. Predominantly affecting infants and older children, these infections have seen a perceived increase in incidence following the coronavirus disease 2019 (COVID-19) pandemic. Our study aims to describe the clinical and epidemiological characteristics of intracranial infections secondary to sinusitis or otitis in the pediatric population and assess changes in incidence and clinical presentation post-pandemic. Specific objectives include analyzing neurosurgical management practices, the role of ENT-neurosurgery cooperation, incidence of epileptic seizures, and management of associated venous thrombosis. A retrospective multicentric study was conducted in hospitals across the Iberian Peninsula, including data from January 2018 to December 2022. Data were divided into pre-lockdown (January 2018 to March 2020) and post-lockdown (March 2020 to December 2022) periods for analysis. The study included 60 pediatric cases (38 post-pandemic and 22 pre-pandemic). The average age was 9.8 years, with a male predominance (61.67%). Sinusitis was the most frequent cause (86%), and the frontal region was the most common site of infection (75%). Neurological symptoms were more prevalent post-pandemic (55.26% versus 23.68%). The primary pathogen was S. intermedius (29.6%). Most patients required neurosurgical intervention (81.7%), with a significant portion undergoing combined ENT-neurosurgery procedures (52.9%). The average antibiotic treatment duration was 6.6 weeks. Complications included venous sinus thrombosis (20%) and seizures (39.2%). Mortality was 3.3%. Although there was a perceived increase in cases post-pandemic, our study observed a normalization of incidence after the lockdown, with a decrease in diagnoses during confinement. The accepted antibiotic regimen lasts 6 weeks, extendable to 8 weeks in non-surgical patients, with at least 2 weeks of intravenous treatment. Sinus surgery combined with antibiotics may suffice to avoid craniotomy in some cases, while combined surgery has a lower reoperation rate in others. Anticoagulation should be individualized and discontinued upon recanalization. Prophylactic antiepileptic drug use remains controversial and should be tailored to patients with specific risk factors. Prolonged antiepileptic drug (AED) therapy may be warranted for those with early seizures and hemorrhagic lesions, whereas others may gradually taper off AEDs after the acute stage.

Catch-22 Situation with Unexpected Reports in Acute Lymphoblastic Leukemia.

AbstractCentral nervous system (CNS) infections are relatively common among children receiving treatment for acute lymphoblastic leukemia (ALL). However, diagnosing these infections presents challenges. In this report, we present a case of asymptomatic adenoviral meningitis, which presented a diagnostic challenge as it mimicked CNS involvement in a child undergoing treatment for ALL. Our findings underscore the importance of thorough diagnostic evaluation for CNS infections in children undergoing ALL therapy, whether they present with symptoms or exhibit asymptomatic cerebrospinal fluid pleocytosis. Furthermore, distinguishing between infections and CNS leukemia is critical, highlighting the necessity of employing flow cytometry to mitigate the potential misinterpretation of morphological features.

Elevated Cerebrospinal Fluid CXCL13 Is a Helpful Marker for the Early Diagnosis of Neuroborreliosis in Children.

Lyme neuroborreliosis (LNB) is an early systemic manifestation of Lyme disease in children, but standard diagnostic measures have constraints that limit early LNB diagnosis. Elevated cerebrospinal fluid (CSF) concentrations of the chemokine CXCL13 are considered a useful marker for early LNB diagnosis in adults, however, few studies have evaluated their diagnostic value in children. In this retrospective analysis, stored CSF samples of 232 hospitalized pediatric patients tested for LNB with standard serological methods were re-analyzed for CXCL13. CXCL13 levels were compared in children classified as definite, possible or no LNB patients according to European Federation of Neurological Societies guidelines. Specificity and sensitivity of CSF CXCL13 were determined for the diagnosis of early LNB, using previously published cutoff levels for pediatric patients. CSF CXCL13 levels differed significantly between 25 patients with definite LNB (all >7.8 pg/mL; range: 37.9->500 pg/mL) and 174 patients without LNB [160 (92%) <7.8 pg/mL; 13 (7%) with a range of 7.8-59.3 pg/mL; 1 (1%) with >500 pg/mL and Ureaplasma parvum CNS infection]. Using a cutoff of 55 pg/mL, CSF CXCL13 resulted in a specificity of 98.9% (95% CI: 97.4-100) and sensitivity of 92.0% (95% CI: 81.4-100). This study confirms the high sensitivity and specificity of CSF CXCL13 for the diagnosis of pediatric LNB using a cutoff value of 55 pg/mL. The use of CSF CXCL13 as an additional diagnostic measure in children with suspected LNB could improve diagnostic specificity and thereby reduce unnecessary antibiotic treatment, especially in the early phases of the disease.

Giant and irregular pituitary neuroendocrine tumors surgery: comparison of simultaneous combined endoscopic endonasal and transcranial and purely endoscopic endonasal surgery at a single center

BackgroundSurgical management of giant and irregular pituitary neuroendocrine tumors (GIPitNETs) presents a significant challenge in neurosurgery. While endoscopic endonasal surgery (EES) is a widely used approach for PitNETs, GIPitNETs with extensive intracranial extension pose challenges for purely EES. We use simultaneous combined endoscopic endonasal and transcranial surgery (CECS) for the treatment of this type of tumor. Currently, there is limited research comparing CECS to EES for GIPitNETs. This study aims to compare the efficacy and short outcome of CECS and purely EES in the management of GIPitNETs to better understand the advantages and limitations of each surgical approach.MethodsThe data of GIPitNETs patients who underwent surgery between March 2018 and May 2023 at a single center were retrospectively reviewed. All included cases were divided into CECS and EES groups according to the treatment modality received. The baseline characteristics and tumor imaging features of patients were compared between the groups, as well as surgical results, perioperative complications, and last follow-up outcomes.ResultsA total of 50 patients met the inclusion criteria, with 27 undergoing CECS and 23 EES. CECS achieved a significantly higher GTR rate compared to EES (66.7% vs. 13.0%, p < 0.0001). CECS had longer operation times and hospital stays, but both approaches had similar rates of complications, including intracranial infection, CSF leakage, new pituitary dysfunction, postoperative diabetes insipidus, and vascular infarction. CECS reduces the risk of postoperative bleeding. Tumor recurrence and reoperation were significantly more common in the EES group.ConclusionsCECS is a safe and effective surgical approach for GIPitNETs, leading to higher rates of GTR, comparable complication rates, and reduced risk of postoperative bleeding when compared to purely EES. EES was associated with more tumor recurrence. Further long-term follow-up data is needed to validate these findings.

Causes of HIV-related CNS infection in Cameroon, Malawi, and Tanzania: epidemiological findings from the DREAMM HIV-related CNS implementation study.

Causes of HIV-related CNS infection in Cameroon, Malawi, and Tanzania: epidemiological findings from the DREAMM HIV-related CNS implementation study.

Frontal sinus mucosa suture closure technique for prevention of cerebrospinal fluid rhinorrhea after bifrontal craniotomy: long-term follow-up results.

Bifrontal craniotomy often involves the bony opening and mucosal disruption of the frontal sinus (FS), which can lead to cerebrospinal fluid (CSF) leakage and meningitis. These complications are particularly associated with surgical treatments for skull base tumors and anterior cerebral artery aneurysms. The authors initially reported on the basic technique in 2014 with 51 cases. This study presents a detailed description of their technique and postoperative management for sealing the exposed FS during bifrontal craniotomy, including long-term follow-up results and outcomes. To objectively evaluate the effectiveness of suturing FS mucosa in preventing CSF leakage during bilateral frontal craniotomy, the authors focused only on anterior cerebral artery aneurysms. This limitation was necessary as other conditions, like extensive tumors or trauma, might lack intact FS mucosa or require its removal due to infection. The records of 34 consecutive patients (median age 62.0 years, mean 60.4 years, range 33-78 years) who underwent bifrontal craniotomy for anterior cerebral artery aneurysms between January 2014 and December 2023 were retrospectively analyzed. All patients had bony opening and mucosal injury of the FS (with exposure to the nasal cavity) that required mucosal suturing. This technique for sealing the exposed FS involves careful dissection of the mucosa from the entire sinus, sterilization with iodine-soaked surgical cotton, and preparation for closure. After the microsurgical procedure is completed, the exposed mucosa is sealed with 6-0 nylon sutures and further secured with fibrin glue-soaked Gelfoam. The bony exposure is covered with an autologous bone flap created from the inner table of the craniotomy bone flap. Finally, the frontal periosteal flap is sutured to the frontal base dura mater. Patients were instructed not to blow their noses for 2 months postoperatively. Two patients experienced transient non-CSF leakage from the nasal cavity, likely due to irrigation fluid, which resolved within 2 days postoperatively. No recurrence was observed during a mean follow-up period of 52.8 ± 41.7 months (median 49 months, range 3-127 months). No cases of meningitis or other intracranial infections were reported. The long-term results demonstrate the sustained effectiveness of this technique in preventing postoperative complications related to FS exposure during bifrontal craniotomy.

The need for epidemiological data on HIV-related CNS infections in low-income and middle-income settings.

The need for epidemiological data on HIV-related CNS infections in low-income and middle-income settings.

Microbial landscape in cerebrospinal fluid of suspected intracranial infections based on clinical metagenomics, a multicentre retrospective study

Microbial landscape in cerebrospinal fluid of suspected intracranial infections based on clinical metagenomics, a multicentre retrospective study

Severe Intracranial Infection.

Severe Intracranial Infection.