Postoperative Central Nervous System Infection Research Articles

Early combined management of frontal sinus and orbital and facial fractures.

Historically, frontal sinus fractures and associated maxillofacial fractures were addressed at different times. We retrospectively reviewed our experience with a series of 79 consecutive patients with bitable frontal sinus fractures, most with associated facial fractures, who underwent early combined cranial and maxillofacial procedures. The operations were performed emergently for patients with open or depressed skull fractures and hematomas with mass effect, and electively within 2 weeks for those with closed fractures. The cranial procedures were performed first. The nasofrontal ducts were packed with "cigars" of bacitracin powder wrapped in Surgicel. All patients received antibiotics for 2 weeks. Postoperatively, good subjective cosmetic results were obtained except in one patient. Eight patients with lumbar drains had expected temporary cerebrospinal fluid (CSF) leaks of less than 72 hours duration. Six postoperative intracranial infections (four cases of meningitis, one epidural empyema, and one intracerebral abscess) were detected; five of these occurred in patients with open depressed fractures. Patients with preoperative CSF leaks (p = 0.0039, Fisher's exact test) and open fractures (p = 0.065, Fisher's exact test) were more likely to develop intracranial infections. The combined neurosurgical and maxillofacial repairs achieved good cosmetic outcomes, with relatively low morbidity. By combining the two-stage procedure into one stage, standard surgical and anesthetic risks could potentially be reduced. Preoperative CSF leaks and open fractures were associated with a higher incidence of postoperative central nervous system infection. Early operations did not appear to be associated with a higher complication rate.

Causes of Infections in Penetrating Head Wounds in the Iran-Iraq War

Abstract Factors seemingly influential in postoperative central nervous system infections were evaluated in 379 patients who sustained missile wounds to the head during the Iran-Iraq War. The mean wound age was 49 hours. The site of injury and presence of retained bone and/or shell fragments did not have a significant effect on infection rate. Thirty-three of 379 patients developed cerebrospinal fluid (CSF) fistulas of which 12 (36%) were associated with infection. The infection rate was 6 of 346 (1.7%) in the absence of CSF leaks. There was a statistically significant association between CSF fistula and infection. All 6 positive cultures in patients with CSF fistulas were gram-negative. Thirty-two patients died during the study, a mortality rate of 8.4%. The mortality rate from infection was 1.8%. Two hundred seventy-seven of 347 patients were followed for a mean of 22 ± 17 months during which time 2 patients were readmitted with central nervous system infections, both due to CSF leakage. CSF fistulas were the main predisposing factor in postdebridement central nervous system infections in this study.

Causes of infections in penetrating head wounds in the Iran-Iraq War.

Factors seemingly influential in postoperative central nervous system infections were evaluated in 379 patients who sustained missile wounds to the head during the Iran-Iraq War. The mean wound age was 49 hours. The site of injury and presence of retained bone and/or shell fragments did not have a significant effect on infection rate. Thirty-three of 379 patients developed cerebrospinal fluid (CSF) fistulas of which 12 (36%) were associated with infection. The infection rate was 6 of 346 (1.7%) in the absence of CSF leaks. There was a statistically significant association between CSF fistula and infection. All 6 positive cultures in patients with CSF fistulas were gram-negative. Thirty-two patients died during the study, a mortality rate of 8.4%. The mortality rate from infection was 1.8%. Two hundred seventy-seven of 347 patients were followed for a mean of 22 +/- 17 months during which time 2 patients were readmitted with central nervous system infections, both due to CSF leakage. CSF fistulas were the main predisposing factor in postdebridement central nervous system infections in this study.

Does Enucleation in the Presence of Endophthalmitis Increase the Risk of Postoperative Meningitis?

The risk of meningitis after enucleation for endophthalmitis has been cited by several authors as a relative contraindication to this procedure. In order to test this theory, we have conducted a review of 165 enucleation and 54 evisceration specimens with a diagnosis of endophthalmitis received from January 1950 through December 1985. This study showed no cases of postoperative central nervous system (CNS) infection. Most patients for whom endophthalmitis was initially suspected received intensive antibiotic therapy. Although cases of post-enucleation meningitis have been reported in the preantibiotic era, the authors conclude that the intensive chemotherapeutic treatment of endophthalmitis today has virtually eliminated the risk of post-enucleation CNS infection.

PRIMARY PULMONARY CRYPTOCOCCOSIS

It is difficult to diagnose primary pulmonary cryptococcosis before operation, and it is often resected to differentiate it from lung cancer. This report describes our three cases of primary pulmonary cryptococcosis, including one case complicated by postoperative meningitis, and reviews 115 cases in Japan. Results indicated that this disease had gradually increased in number each year. The ratio of male to female was 6:1. The disease rarely produced symptoms and was often discovered at health examinations. People age 20-59 years were most frequently affected. It generally appeared as a nodular or tumor-like shadow on chest X-ray film, but not as a calcification. Treatment consisted of antimycotic agents and/or resection. The prognosis was good irrespective of method of treatment, but two postoperative central nervous system (CNS) infections occurred. It is desirable to carefully observe patients not given antimycotic agents whose lesion is a single nodule or has been resected in advance because the disease has a tendency to heal spontaneously and defense against CNS infection necessitates medications with many side effects.