Secondary Meningitis Research Articles

Prevalence and Antimicrobial Susceptibility Pattern of Acinetobacter baumannii Complex in Clinical Samples Among Patients at a Tertiary Care Hospital, Jaipur

Aims and objectives: Acinetobacter causes a wide spectrum of infections, including nosocomial pneumonia, secondary meningitis, surgical wound infections, skin and soft tissue infections, urinary tract infections, bacteraemia, and transmission via the hands of hospital personnel. The study aimed to determine the prevalence of Acinetobacter baumannii complex isolates and the antimicrobial susceptibility pattern of isolated A. baumannii complex. in clinical samples among patients at Mahatma Gandhi Medical College and Hospital. Introduction: In recent decades, Acinetobacter baumannii (A. baumannii) infections have also occurred outside the ICU or in trauma patients after natural disasters, and they have even affected patients after co-morbidities in the community. Materials and methods: All A. baumannii complex isolates (non-repetitive) from different clinical samples received in a clinical microbiology laboratory from inpatients and outpatients at Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, were included in the study. Routine microscopy of the samples was done. Gram‘s staining was done on all samples except urine. All clinical samples were inoculated on blood agar and MacConkey agar and incubated at 370 °C for 18–24 hours. Antimicrobial susceptibility testing of the isolated A. baumannii complex was done by the VITEK2-AST Compact system. Results: Among 6483 samples, 157 (2.42%) A. baumannii complex isolates were culture-positive, 68.37% were sterile, and 29.19% were other culture-positive. The maximum sensitivity of A. baumannii isolates was seen to be Tigecycline (70%), followed by Minocyclin (29.9%), while maximum resistance was observed for Piperacillin/Toazobactam (97%), followed by Imipenem, Meropenem (96.8%), Ceftazidime (96%), Cefepime (91.7%), Cipropfloxacin (88%), and Gentamycin (87%). Conclusion: Based on this study, it could be concluded that, as antibiotic resistance increases, hardships will be experienced in A. baumannii complex treatment unless the necessary precautions are taken and new antibiotics are discovered. In order to prevent the spreading of resistant Acinetobacter strains, infection control measures should be taken, clinicians and laboratory workers should cooperate during antibiotic use, and hospital hygienic rules should be observed.

ПРОТИВОМИКРОБНАЯ ТЕРАПИЯ ПРИ РИНОСИНУСОГЕННЫХ ОСЛОЖНЕНИЯХ: ВЗГЛЯД КЛИНИЧЕСКОГО ФАРМАКОЛОГА

Rhinosinusogenic orbital (RSOC) and intracranial complications (RSIC) remain relevant for physicians of various specialties due to high risks of unfavorable outcomes. The key to successful medical care of patients with complicated forms of nasal and paranasal sinus pathology is not only untimely diagnosis and surgical sanation of the primary focus of infection, but also properly selected systemic antimicrobial therapy (SPMT), the choice of which is based on local data on the structure of pathogens and their sensitivity to antibacterial drugs. As a result of retrospective analysis of medical records of 266 completed cases of complicated forms of rhinosinusitis in adult patients for the period from 2010 to 2023, the peculiarities of the course of RSOC and RSIC, the microbial landscape in this pathology, the nature and extent of SPMT were studied. It was revealed that in the structure of the complicated course of RSOC occupy the leading positions. Secondary meningitis prevailed among RSIC, accounting for (92.6%). Clearly expressed changes of inflammatory character on the part of the general blood analysis and integral hematologic indices were characteristic for RSIC and purulent-inflammatory complications of the eyes. Staphylococcus spp. prevailed in the structure of etiologic factors in RSOC, while polymorphism of the isolated microflora was observed in RSIC (Staphylococcus spp., Streptococcus spp., Enterobacterales, Acinetobacter spp., Enterococcus spp., anaerobes, Candida spp., Mucor spp). Analysis of antibiograms revealed that the most problematic in terms of the choice of SPMT were representatives of the order Enterobacterales, Acinetobacter spp., in some established ones - Enterococcus spp., among the pathogens of mycosis - Mucor spp. 3-generation cephalosporins prevailed in the structure of empirical SPMT, and to a lesser extent inhibitor-protected aminopenicillins. However, the severity of the patients' condition, especially in case of RSIC, the results of microbiologic examination dictated the need to switch to "observation" antibiotics (meropenem, cefepime). Timely diagnosis, clear tactics of medical care, including the choice of effective SPMT led to favorable outcomes in 98.8% of patients.

ВТОРИЧНЫЕ ГНОЙНЫЕ ОТОГЕННЫЕ МЕНИНГИТЫ У ВЗРОСЛЫХ: ОСОБЕННОСТИ ПРОТИВОМИКРОБНОЙ ТЕРАПИИ

Secondary purulent otogenic meningitis (SPOM) in adult patients is less common than in children, but among all intracranial complications of middle ear pathology it occupies the leading position. In the absolute majority of cases, a patient with SPOM on admission to the emergency room is supervised by a neurologist with a suspicion of acute cerebral circulation disorder, and an otorhinolaryngologist, along with other subspecialists, is initially an invited consultant. All this is associated with the risks of untimely diagnosis of SPOM and inadequate tactics of medical care, including the rationality of prescribing the choice of systemic antimicrobial therapy (SPMT), which increases the likelihood of unfavorable outcomes. As a result of retrospective analysis of medical records of 33 completed cases of SPOM for the period from 2017 to October 2023, the features of the course of SPOM microbial landscape in this pathology and the nature of SPMT were studied. It was revealed that in the structure of secondary meningitis of otogenic and rhinosinusogenic etiology VHOM took the leading positions (81.1%). In 62.5% of cases, patients had comorbid pathology, which negatively affected the course of the underlying disease and worsened the prognosis of the disease. Such manifestations as headache, vomiting, disorders of consciousness were observed in 62.5%, 57.6%, 62.1% of cases, respectively. Clearly expressed signs of inflammatory process on the part of general blood analysis and cerebrospinal fluid were revealed. The structure of etiologic factors in adult SPOM was dominated by coccal microflora (S.pneumoniae, Streptococcus spp., Staphylococcus spp.). In 81.8% of cases of SPOM we started with recommended ceftriaxone, but absence of positive dynamics, severity of the course of the inflammatory process required correction of SPMT and transition to meropenem. Timely diagnosis, clear tactics of medical care, including the choice of effective SPMT using, including de-escalation schemes, led to favorable outcomes in 87.9% of patients.

Early life parechovirus infection neuropsychological outcomes at 8 years: a cohort study

ABSTRACT Human parechovirus (HPeV) is a leading cause of Central Nervous System (CNS) infection in infancy. Despite this, little is known regarding the long-term neuropsychological impacts from HPeV infection. The aim of the present study was to explore the long-term neuropsychological impacts eight-year post-HPeV infection contracted during infancy. This study also aimed to investigate the differential impacts of HPeV itself compared to the effects of secondary meningitis (n = 23) or encephalitis (n = 3) associated with HPeV infection. Thirty-nine HPeV children participated in the study. Children completed performance-based measures of neuropsychological and language functioning (the Wechsler Abbreviated Scale of Intelligence, the Clinical Evaluation of Language Fundamentals – Fourth Edition, and the Test of Everyday Attention for Children). Parents completed questionnaire-based measures of emotional, behavioral, and pragmatic language functioning (the Behaviour Rating Inventory of Executive Functioning, the Child Behavior Checklist, and the Social Communication Questionnaire). Results revealed that, overall, children with HPeV were significantly more impaired on measures of selective, sustained, and divided attention compared to normative test populations. The current study incidentally found at least double the prevalence of Attention-Deficit/Hyperactivity Disorder (ADHD) in the HPeV sample than what is typical in the normal population, suggesting that HPeV infection during infancy may be a risk factor for the later development of ADHD. Additionally, the presence of secondary meningitis or encephalitis did not relate to poorer neuropsychological outcomes in the current sample. The findings of this study have important implications regarding clinical management for children following HPeV infection in infancy.

Risk factors for external ventricular drainage infections.

External ventricular drainage (EVD) is frequently used in neurosurgical interventions to drain cerebrospinal fluid (CSF). Nevertheless, it carries ahigh incidence of infectious complications, notably secondary meningitis and ventriculitis. In light of the previous rates of these EVD-related infections, we introduced aset of guidelines to lower the infection rate. This study aimed to assess the influence of the hospital-wide adoption of the EVD handling protocol on secondary infections related to EVD. We enrolled 171 patients scheduled for EVD placement for reasons other than infectious meningitis or ventriculitis from January 2021 to March 2024. Amatched cohort of patients underwent logistic regression to adjust for and analyze regression discontinuity. Infections were more prevalent in the group before the protocol'simplementation (18.27% compared to 7.46%, p<0.0001). Regression analysis within the matched score cohort (n=104 in pre-protocol groups and n=67 in post-protocol groups) indicated that the period before the protocol was independently linked to ahigher incidence of infections. Implementing astringent hospital-wide protocol for EVD handling can significantly diminish the rate of secondary infections associated with EVD (Tab. 3, Fig. 1, Ref. 15). Text in PDF www.elis.sk Keywords: external ventricular drainage, meningitis, ventriculitis, infection.

Impact of an external ventricular shunt (EVD) handling protocol on secondary meningitis rates: a historical cohort study with propensity score matching

BackgroundExternal ventricular drainage (EVD) is frequently used in neurosurgical procedures for cerebrospinal fluid (CSF) drainage. It is, however, associated with high infection rates, namely secondary meningitis and ventriculitis. Based on a previous high prevalence of these infections among patients with EVDs, we have proposed and implemented a protocol in an effort to decrease the infection rate. The aim of this study was to measure the effect of hospital-wide implementation of the EVD handling protocol on secondary EVD infections.Patients and methodsWe included 409 consecutive patients who received a new EVD for other indications than infectious pathologies from January 2000 until June 2012. Patients above 18 years of age were divided into pre- (n = 228) and post-protocol (n = 181) groups. Patient and disease demographics, as well as EVD data together with confounders for secondary meningitis were recorded in a database. Propensity score matching was then performed to create groups matched for sex, age, reason for drainage, type of shunt, time in situ and duration of surgery to place the EVD. Binomial logistic regression for confounder adjustment and regression discontinuity analyses were then performed on the matched cohort.ResultsInfections occurred more frequently in the pre-protocol group (23% vs 9%, p < 0.001). The incidence of infection was 33/1000 drain-days pre-protocol and 9/1000 drain-days post-protocol. Regression analysis in a propensity score-matched cohort (n = 103 in the pre- and n = 178 in the post-protocol groups) showed that the pre-protocol period was independently associated with more infections (OR 2.69; 95%-CI 1.22–5.95, p = 0.01).ConclusionsThe incidence of secondary EVD infections can be reduced significantly by the implementation of a strict hospital-wide EVD handling protocol.

Modelling the Transmission Dynamics of Meningitis among High and Low-Risk People in Ghana with Cost-Effectiveness Analysis

Meningitis is an inflammation of the meninges, which covers the brain and spinal cord. Every year, most individuals within sub-Saharan Africa suffer from meningococcal meningitis. Moreover, tens of thousands of these cases result in death, especially during major epidemics. The transmission dynamics of the disease keep changing, according to health practitioners. The goal of this study is to exploit robust mechanisms to manage and prevent the disease at a minimal cost due to its public health implications. A significant concern found to aid in the transmission of meningitis disease is the movement and interaction of individuals from low-risk to high-risk zones during the outbreak season. Thus, this article develops a mathematical model that ascertains the dynamics involved in meningitis transmissions by partitioning individuals into low- and high-risk susceptible groups. After computing the basic reproduction number, the model is shown to exhibit a unique local asymptotically stability at the meningitis-free equilibrium E † , when the effective reproduction number R 0 &lt; 1 , and the existence of two endemic equilibria for which R 0 † &lt; R 0 &lt; 1 and exhibits the phenomenon of backward bifurcation, which shows the difficulty of relying only on the reproduction number to control the disease. The effective reproductive number estimated in real time using the exponential growth method affirmed that the number of secondary meningitis infections will continue to increase without any intervention or policies. To find the best strategy for minimizing the number of carriers and infected individuals, we reformulated the model into an optimal control model using Pontryagin’s maximum principles with intervention measures such as vaccination, treatment, and personal protection. Although Ghana’s most preferred meningitis intervention method is via treatment, the model’s simulations demonstrated that the best strategy to control meningitis is to combine vaccination with treatment. But the cost-effectiveness analysis results show that vaccination and treatment are among the most expensive measures to implement. For that reason, personal protection which is the most cost-effective measure needs to be encouraged, especially among individuals migrating from low- to high-risk meningitis belts.

Community-Acquired Acinetobacter radioresistens Bacteremia in an Immunocompetent Host

Acinetobacter species are gram-negative coccobacilli ubiquitousin nature and widely distributed in the environment. Acinetobacter baumannii isa bacteria commonly seen in the hospital setting, responsible for causinga wide range of bloodstream infections, urinary tract infections, secondary meningitis, infective endocarditis, and wound infections, and is the cause of outbreaks mainly due to its antimicrobial resistance patterns. The use of broad-spectrum antibiotic coverage with carbapenems is essential in the hospital setting. Therefore, carbapenem-resistantAcinetobacter baumannii(CRAB) poses as a very challenging pathogen.Acinetobacter radioresistens, a rare species in comparison to the more prevalentAcinetobacter baumannii, isan underestimated agent in causing nosocomial infections and also is a potential disseminator of resistance genes.It is also resistant to gamma radiation at 4-8 times higher than other Acinetobacter spp. andis the source of the class D OXA-23 carbapenemase that can confer carbapenem resistance. Therefore,immediate and precise identification of A. radioresistens is crucial for the clinical management of multidrug-resistant bacteremia.

Development and Clinical Application of a Recombinase Polymerase Amplification-Lateral Flow Strip Assay for Detection of Carbapenem-Resistant Acinetobacter baumannii.

Acinetobacter baumannii is a worldwide, primary cause of respiratory tract infections, septicemia, urinary apparatus infections, and secondary meningitis. It can be fatal. Rapid and accurate detection methods are needed to control the spread of carbapenem-resistant A. baumannii (CRAB). Current molecular diagnostic methods are limited and not suitable for on-site detection. In this study, an isothermal detection method using recombinase polymerase amplification (RPA) combined with a lateral flow strip (LFS) was developed to target the bla OXA-51 and bla OXA-23 genes of A. baumannii. The reaction was completed in about 40 min at 37°C. This method can also effectively distinguish A. baumannii and CRAB. The limit of detection of 100-101 CFU/reaction was equal to that of other detection methods. The detection accuracy was equal to that of the qPCR method with the use of clinical samples. The RPA-LFS assay is portable, rapid, and accurate and could replace existing detection methods for on-site detection of A. baumannii and CRAB.

Meropenem Resistance among Acinetobacter Positive Clinical Samples in a Tertiary Care Centre in Nepal: A Descriptive Cross-sectional Study.

Antimicrobial-resistant Acinetobacter species are implicated in a variety of infections including nosocomial bacteraemia, secondary meningitis, and urinary tract infections. Carbapenem including meropenem-resistant Acinetobacter is recognized as one of the most difficult antimicrobial resistant gram-negative bacilli to control and treat. It was classified as an urgent threat by Centers for Disease Control and Prevention in 2019 Antibiotic Resistance Threats Report. This study was carried out to determine the prevalence of meropenem resistance among acinetobacter positive clinical samples in a tertiary care centre. A descriptive cross-sectional study was carried out in microbiology department of Clinical Laboratory Services among Acinetobacter positive clinical samples of a tertiary care center in Nepal. The culture and sensitivity reports of various clinical samples from April 2018 to April 2020 which were positive for Acinetobacter species were taken from hospital records section. Convenience sampling was done. Meropenem-resistant Acinetobacter samples were studied. Ethical approval was received from Institutional Review Committee (Ref No. 076/77/40). Analysis of data was done using Statistical Package for the Social Sciences version 26. Point estimate at 95% Confidence Interval calculated with frequency. Out of 121 Acinetobacter isolates, prevalence of meropenem-resistant Acinetobacter was reported in 93 (76.9%) at 95% Confidence Interval (69.39-84.40). Among the meropenem-resistant Acinetobacter samples, most of the samples were collected from the sputum 70 (75.2%) followed by blood 8 (8.6%). High prevalence of meropenem-resistant Acinetobacter species in our hospital setting is alarming. In addition, there is emergence of resistance against even the last resort drugs which is creating a treatment crisis.

Evaluation of the national surveillance system for invasive meningococcal disease, Italy, 2015-2018.

Enhanced laboratory-based surveillance of invasive meningococcal disease (IMD) in Italy was only assessed indirectly by numerically comparing surveillance data cases with hospital discharge records (HDR). In this study, we evaluated the completeness, timeliness and sensitivity of the IMD surveillance in Italy from 2015 to 2018. Completeness and timeliness were described at the national and subnational level. A capture-recapture analysis was conducted to evaluate the sensitivity and positive predictive value (PPV) using HDR as the external source with a combination of deterministic and probabilistic approaches. The characteristics of the unmatched vs. matched cases were compared using multivariable Poisson modeling. Overall, the completeness of data improved, except for specific variables. Timeliness of notifications also improved to a median of 4 days from onset to reporting. For the years 2015–2017, the sensitivity of the surveillance was estimated at 71.4% and the PPV at 77.5%, changing to 80.6% and 66.9% respectively after removing cases with a secondary meningitis diagnosis. We noted substantial sub-national differences. In 2018 sensitivity was 66.5% (135/203) and the PPV was 79.4% (135/170). The adjusted relative risk of being unmatched in 2015–2017 was higher in cases that were ≥60 years, had missing information or symptom onset in December. The IMD surveillance system overall performs well with completeness and timeliness improving in time. Specific challenges identified for individual variables should guide further improvement. Notwithstanding limitations posed by the comparison database, sensitivity and PPV are promising. The study highlights that promoting etiological ascertainment in people ≥60 years and addressing sub-national challenges are the main current challenges to address.

A case of secondary bacterial meningitis against the background of transethmoidal meningoencephalocele

The article represents a clinical case of secondary bacterial meningitis in a patient with meningoencephalocele, craniopathy rarely found in adults. The features of the course of the disease, diagnosis and treatment are discussed. Meningoencephalocele is a prolapse of the arachnoid membrane with brain substance due to craniopathy. Most cases of this disease are related to malformations detected in childhood. In adults, meningoencephalocele can be a consequence of injury, iatrogenesis, or some disease of unknown etiology. In this case, we can speak of spontaneous meningoencephalocele. The cause of this pathology is currently considered the effect of increased intracranial pressure on the “vulnerable” cranial areas: the Turkish saddle diaphragm, the walls of the sphenoid sinus, the ethmoid plate. Surgical treatment of intracranial hypertension is another factor likely to influence the occurrence of meningoencephalocele. Nasoliquorrhea is the most common symptom that causes patients with encephalocele health encounter. 33% of those are diagnosed with meningitis. Neuroimaging plays a key role in encephalocele diagnosis. Computed tomography of the brain can detect craniopathy. Leptomeningeal accumulation of contrast agent on T1-weighted images on magnetic resonance imaging indicates inflammation of the meninges in a patient with a clinical picture of meningitis. Encephalocele treatment is surgical. In the clinical case presented in this article, the patient with noncommunicating hydrocephalus and a history of surgical treatment of a colloid cyst was diagnosed with bacterial meningitis. Computed tomography of the head revealed a defect of the ethmoid bone and meningoencephalocele. The radiological signs of meningoencephalocele and meningitis are presented according to the data of magnetic resonance imaging in this patient. The patient underwent a two-stage surgical treatment with the use of endoscopic techniques and craniotomy. Four years after the operation, the radiological picture and the outcome of the disease were assessed.

Establishment of a Nomogram for Predicting Lumbar Drainage-Related Meningitis: A Simple Tool to Estimate the Infection Risk.

Lumbar drainage (LD) is one of the common treatment techniques in neurosurgery. There is a risk of secondary meningitis when using this modality. We aim to predict the probability of the complication by designing a nomogram. A retrospective study was conducted in a teaching hospital. Data were collected and LD-related meningitis (LDRM) was identified, mainly based on clinical manifestations and cerebrospinal fluid analysis. Univariate analysis was used to screen the risk factors, and binary logistic analysis was performed to build the prediction model, which was furtherly transferred into a nomogram. The prediction performance was evaluated by receiver operating characteristic (ROC) curve, Hosmer-Lemeshow test, and nomogram calibration plot. Internal validation was processed by using ordinary bootstrapping. A total of 273 patients who match the research criteria were enrolled, in which 37 cases (13.6%) were confirmed to have LDRM. Univariate analysis showed the risk factors included diabetes (p = 0.003), admission on surgical intensive care unit (p = 0.012), duration time (p < 0.001), site leakage (p < 0.001), and craniotomy (p < 0.001). In multivariate analysis, four of the variables were identified as independent risk factors to establish a prediction model, and a graphical nomogram was designed. The area under the ROC curve was 0.837, and the p value in the Hosmer-Lemeshow test was 0.610, with a mean absolute error in the calibration plot calculated as 0.022. The indices in the testing set were in good accordance with the original set when internal validation was performed. This is the first study to transform the prediction model of LDRM into a nomogram, which can be considered as a tool for clinicians to assess infection risk.

Microsurgical treatment of distal aneurysms of the posterior inferior cerebellar artery

The study objective is to analyze characteristics of distal aneurysms of the posterior inferior cerebellar artery (PICA) using the results of surgical treatment of 11 patients with this disorder.Materials and methods. Eleven patients with distal PICA aneurysms (7 men and 4 women aged between 32 and 57 years (mean age 44 years)) were operated in N.V. Sklifosovsky Research Institute for Emergency Medicine. Aneurysms were visualized using cerebral angiography in 2 patients and using computed angiography in 9 patients. The aneurysms were classified using the classification system developed by J.R. Lister and A.L. Rhoton. Aneurysms located in the tonsillomedullary segment were most common. Saccular aneurysms were found in 7 (64 %) patients, whereas fusiform aneurysms were observed in 4 (36 %) patients. Two saccular aneurysms had a large neck. The size of aneurysms varied between 2 and 9 mm. The majority of patients (70 %) had aneurysms less than 7 mm.Results. Five patients were operated via median suboccipital approach, while the remaining 6 patients were operated via lateral suboccipital approach. We performed either reconstructive (n = 9) or deconstructive (n = 2) aneurysm clipping depending on the possibility of preserving the PICA lumen and presence of damage to the perforating arteries of the brain stem. Nine patients (82 %) had Glasgow Outcome Score of 5; two patients (18 %) died (one of them was admitted in sopor with occlusive hydrocephalus; another one had grade III–IV obesity and developed purulent septic respiratory complications and secondary purulent meningitis). Two patients (18 %) developed dysarthria and dysphagia in the postoperative period, but these symptoms disappeared by the moment of discharge.Conclusion. Distal PICA aneurysms are quite rare and require tailored approach to treatment. A surgeon should bear in mind specific anatomical characteristics of aneurysms, control arterial patency when isolating the aneurysm from the bloodstream, and use revascularizing methods whenever possible. In addition to that, a surgeon should be extremely careful during manipulations with perforating arteries of the brain stem and distal cranial nerves, because their damage result in a more difficult postoperative period.Conflict of interest. The authors declare no conflict of interest.Informed consent. All patients gave written informed consent to participate in the study and to the publication of their data.

Secondary Meningitis to Osteomielitis of Cranial Vault Due to Squamous Cell Carcinoma of Hair Skin, Report of a Case

We report the case of a 91-year-old patient who presents a syncopal picture so that when she falls from her own height she suffers severe skull-brain trauma with loss of consciousness, the cerebral CT scan shows subarachnoid hemorrhage and the presence of intracranial bleeding with signs of herniation cerebral, the evolution is towards frank deterioration with subsequent death, had as background the resection of a carcinoma in the scalp with the completion of a flap.

Conquering the Rock-A Retrospective Single-Center Experience of the Transapical Petrosal Transtentorial (Kawase) Approach: Operative Technique and Impact on Cranial Nerve Function.

Since its description in 1985, the transapical petrosal transtentorial or Kawase approach has become a viable option of approaching lesions located in and around the apex of the petrous bone, Meckel's cave, and the anterolateral surface of the brain stem while preserving cranial nerve function. At the Brain Tumor Center, Erasmus MC, 25 patients were treated using the Kawase approach between 2004 and 2018 for various indications, including petroclival meningiomas, chondrosarcomas, pontine cavernomas, trigeminal schwannomas, and posterior circulation aneurysms. Hearing preservation was achieved in all patients; new abducens nerve and trochlear nerve palsies were present in three and six patients, respectively, of which a total of eight required ophthalmological correction. Seven patients experienced a cerebrospinal fluid fistula postoperatively, but this complication appeared self-limiting in all cases, with one patient experiencing secondary meningitis. After modifying our closure technique, the rate of fistulas dropped to zero. The observed direct postoperative mortality was 4% (one patient), although not related to the approach itself. In conclusion, the Kawase approach is a highly complex, but essential middle fossa approach, extremely robust, and able to serve a wide array of pathologies together with its extensions. It is very accurate for performing hearing preservation surgery, but not without caveats and inherent risk of complications.

Posterior cranial fossa and spinal local infections

The aim of this paper is to review the current knowledge on the management of local infections in posterior cranial fossa (PCF) and spinal surgery; the center of our paper will be the diagnosis and management of infections of the wound, the subcutaneous tissue, and muscle strata. Very few papers address the problem of local infections in posterior cranial fossa and spinal surgery. The largest amount of the literature data is indeed centered on how to deal with deep infections, CSF leak, and secondary meningitis or hardware infection. Concerning PCF surgery, a higher rate of local infections has been reported, compared with supratentorial surgery. To prevent such complications, prophylaxis remains the most important tool in dealing with local infections; a careful surgical planning and patient selection are also important. On the other hand, in dealing with local infection in spinal setting, there are several evidences that local vancomycin might help reducing them in adults as well as in children. The treatment protocol consists in antibiotic therapy and, whenever needed, wound revision to remove infectious material or to obtain a microbiological diagnosis. Prognosis has overall to be considered favorable both in the short term as well as in the long term.

Thoracic Paravertebral Abscess and Secondary Meningitis in a Hemodialysed Patients: Case Presentation

Thoracic Paravertebral Abscess and Secondary Meningitis in a Hemodialysed Patients: Case Presentation

Clinical analysis of extended endoscopic endonasal approach for craniopharyngioma treatment

Objective To evaluate the efficacy and safety of extended endoscopic endonasal approach for resection of craniopharyngiomas. Methods The clinical data of 32 patients with craniopharyngiomas undergoing extended endoscopic endonasal surgery at Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University between November 2014 and May 2016 were analyzed retrospectively. The visual improvement, extent of resection and surgical complications were evaluated. Results The gross total resection (GTR) rate was 69% (22/32), near-total resection (> 95% of tumor removed) was 25% (8/32), and subtotal resection (≥ 80% of tumor removed) was 6% (2/32). Overall, 28 patients presented with visual impairment. In 86% (24 patients) of them, visions were improved or even recovered to normal following surgery. Worsening of the anterior pituitary function was reported in 53% (17 patients) of all, and there were 12 new cases (48% of 25) of postoperative diabetes insipidus. Thirteen (41%) patients had hyposmia and 3 (9%) patients developed severe hypomnesia after surgery. CSF leakage and secondary meningitis occurred in 1 (3%) patient postoperatively. One (3%) patient had brainstem hemorrhage after surgery. The follow-up lasted 4-22 months. No tumor recurrence was identified by MRI examination, and one patient died. Conclusions The extended endoscopic endonasal approach for craniopharyngiomas seems generally effective and safe with high GTR rate, which however could also cause damage of hypothalamic-pituitary axis. Thus, continuous attention should be paid to preservation of the endocrine function during surgical management of craniopharyngioma. Key words: Craniopharyngioma; Neuroendoscopy; Neurosurgical procedures; Treatment outcome; Extended endonasal approach

Cerebral neurological complications in patients with thermal injury

Relevance. Treatment of patients with severe thermal injury includes therapy comorbidities and complications, among which the special role played by the central nervous system. Their development is largely determines the weighting of the condition worsens the prognosis, as well as leading the timing of recovery. For burn disease may be accompanied by the development of the cerebral neurological complications, such as burn encephalopathy, acute violation of cerebral circulation, secondary purulent meningitis. Intention – identify the main pathogenetic mechanisms of neurologic complications and their correction have burned. Methods Review and analysis of literature data on neurological complications from burned and their treatment options. Results and Discussion. In the genesis of neurological disorders in the burned main role constitute the hemodynamic, electrolyte disorders, violations, breach the blood-brain barrier in the face of intoxication. Develops complex disorders, which can result in secondary purulent meningitis and meningoencephalitis. A comprehensive treatment, including surgical restoration of the skin integument, infusion therapy, antibiotics, drugs neuroprotektors stimulants avoids a number of severe complications. Conclusion. Timely pathogenetically justified treatment of neurological complications in burned, carried out within the framework of the integrated therapy of burn disease is essential, because such an approach contributes to the best possible outcomes.