1/44. A surgical method for treating anterior skull base injuries.skull base surgery was performed on 18 patients with anterior skull base injuries. The operative technique consisted of opening the operative field in the anterior skull base via a coronal incision and a frontal craniotomy, debridement of the anterior skull base including the injured dura mater, performing drainage from the anterior skull base to the nasal cavity by ethmoidectomy, and reconstructing the resulting dural and anterior skull base defect using bilateral temporal musculo-pericranial flaps and a bone graft. Seventeen of the 18 patients recovered without any complications, although epidural abscesses in the anterior skull base had been present in four patients at the time of the operation. Only one patient developed an epidural abscess in the anterior skull base after the operation. None of the patients developed any other complications including meningitis, recurrent liquorrhoea or cerebral herniation. Satisfactory aesthetic results were achieved in 16 of the 18 patients. In one patient, uneven deformity of the forehead, which was caused by the partial sequestration of the frontal bone due to postoperative infection, was observed. In another patient, a depressed deformity of the forehead, which was caused by the partial loss of the frontalis muscle following the use of the frontal musculo-pericranial flap instead of a temporal musculo-pericranial flap, was observed. Anterior skull base reconstruction using bilateral temporal musculo-pericranial flaps provides excellent results in terms of patient recovery and aesthetics.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
2/44. Brain abscesses from neglected open head injuries: experience with 17 cases over 20 years.We are reviewing our experience with 17 civilian cases with post-traumatic brain abscesses treated in the era of CT scanning over a period of 20 years. The principal cause for this intracranial complication was the neglected compound depressed fracture. One was a newborn infant with left parietal abscess caused by a vacuum extraction. We have used the following methods of treating the abscesses: single burr hole aspiration in the newborn with an excellent result; repeated aspiration, with debridement of the depressed fracture, in 5 cases (1 death); aspiration with early subsequent excision, via craniotomy, in 7 cases (no death), and primary excision, via craniotomy, in 4 cases (1 death). The early subsequent excision of the abscess, 2 or 3 days after the initial aspiration, has proved in our experience very satisfactory. In cases with bone fragment into the abscess cavity the excision of the abscess is indicated. The cultured pus from the abscess cavity showed mixed flora (streptococci and staphylococci) in 7 cases; staphylococcus aureus in 4; staphylococcus epidermidis in 2, and no growth in 4 cases. Antibiotics play an important role in the treatment of post-traumatic brain abscesses.- - - - - - - - - - ranking = 2keywords = cavity (Clic here for more details about this article) |
3/44. brain abscess formation in radiation necrosis of the temporal lobe following radiation therapy for nasopharyngeal carcinoma.BACKGROUND: radiation necrosis is a known complication following radiation therapy for extracranial as well as intracranial tumours. However, brain abscess formation in radiation necrosis has not been reported in the literature. We report the clinical data of 6 patients suffering from this condition. METHOD: Twenty-eight patients with radiation necrosis of the temporal lobe following radiotherapy for nasopharyngeal carcinoma were treated surgically at the Department of neurosurgery, Queen Elizabeth Hospital, hong kong between January 1992 and July 1999. Of these, 6 cases were complicated by brain abscess formation. The clinical data of these 6 patients are retrospectively reviewed. FINDINGS: The patients were 5 males and 1 female, ranging in age from 41 to 67 years. Three patients had previous treatment with steroids for the symptomatic radiation necrosis. A history of nasal infection or otitis media was recognised in all 6 patients. All patients were treated surgically by temporal lobectomy and excision of the necrotic tissue together with the abscess cavity. Intra-operatively, a bony defect was observed between the middle cranial fossa and the sphenoid sinus in 3 patients and the bony defect was repaired with a temporalis muscle flap. The species of organisms could only be identified in 3 patients. In 3 patients, the pus smear was positive but the culture was negative. Subsequently, 4 patients recovered and 2 patients died. INTERPRETATION: Cerebral radiation necrosis is a predisposing cause of brain abscess formation. Surgical excision is recommended as the treatment of choice in this group of patients.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
4/44. brain stem abscess treated surgically. Wtih special note upon the employment of thorium dioxide.A 10-year-old girl, with congenital heart disease, harboring a brain stem abscess, was recently treated at the UCLA Hospital. Needle aspirations of the abscess was performed through a posterior occipital craniectomy, and thorium dioxide (Thorotrast) was placed within the abscess cavity as a marker. Postoperatively, the patient improved temporarily but died 18 days later. autopsy examination included radioactive analysis of brain and liver tissue. Radioautographs were superimposed on H&E preparations of the abscess wall to localize the extent of activity of the thorium dioxide. The unusual occurrence of this abscess in a young patient, clinically diagnosed and treated by operation, provided a rare opportunity to assess the problem of the surgical accessibility of brain stem abscess as well as to reevaluate a role for thorium dioxide as a marker for intracranial purulent collections.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
5/44. Successful treatment of invasive mould infection affecting lung and brain in an adult suffering from acute leukaemia.We describe in detail a 67-yr-old woman who was treated with a cytostatic combination chemotherapy for newly diagnosed common-acute lymphoblastic leukaemia. At the end of induction therapy, the patient acquired invasive mould infection affecting lung and brain. The patient entered complete remission of her leukaemia. Treatment with liposomal amphotericin b was initiated along with surgical excision of the fungal brain abscess. Intrathecal instillation of amphotericin b deoxycholate was started using an Ommaya reservoir because of an anatomical connection between the postoperative cavity and the ventricle. Full dose cytostatic chemotherapy was continued with little delay. A computerised tomography scan of the chest performed 2 months later revealed no fungal abscesses. magnetic resonance imaging of the brain did not reveal any fungal manifestation. During maintenance therapy/week 69, the patient relapsed from leukaemia. High doses of intravenous liposomal amphotericin b were administered prophylactically. The patient's leukaemia proved refractory to reinduction chemotherapy and the patient died from pneumonia 8 wk later. Post mortem microbiological investigation and histopathological examination of lung and brain tissue did not reveal any macroscopical or microscopical fungal manifestations. This case underlines the feasibility and successful application of combined antileukaemic, antifungal and surgical therapy in a patient with acute leukaemia.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
6/44. diffusion-weighted imaging and apparent diffusion coefficient maps in a case of intracerebral abscess with ventricular extension.Previous findings have demonstrated the diagnostic usefulness of diffusion-weighted imaging in depicting specific features of a brain abscess. We report a case of a cerebral abscess, which ruptured into the ventricular system, including its findings on both diffusion-weighted images and apparent diffusion coefficient (ADC) maps. Purulent material within the left lateral ventricle, similar to that of the central abscess cavity, was strongly hyperintense on diffusion-weighted images. However, variable signal intensity changes were observed on the ADC map; these probably corresponded to regional variation of the concentration of protein in the purulent material. In this case, both diffusion-weighted images and ADC maps were important and complementary in the evaluation of ventricular extension of an intracerebral abscess.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
7/44. Cerebellar aspergillosis: case report and literature review.OBJECTIVE AND IMPORTANCE: An unusual, but not unique, case of cerebellar aspergillosis associated with autologous peripheral blood stem cell transplantation for breast cancer is presented. CLINICAL PRESENTATION: A 45-year-old woman with breast cancer underwent chemotherapy and radiotherapy as well as autologous peripheral blood stem cell transplantation. She developed a cerebellar aspergillosis abscess that was treated successfully with two surgical resections. INTERVENTION: After removal of pus and the abscess wall, the patient received local application of amphotericin b (AmB). She received AmB 1 mg/kg/d for 3 months and itraconazole 100 mg/kg/d for 1 year. After 3 months of AmB treatment, magnetic resonance imaging revealed that disease had not recurred. CONCLUSION: In cases of central nervous system aspergillosis, to increase the therapeutic efficiency, AmB can also be applied to the abscess cavity. Computed tomographic and contrast-enhanced magnetic resonance imaging scans play an important role in establishing early diagnosis in high-risk, immunocompromised patients.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
8/44. Primary brain abscess with nocardia farcinica in an immunocompetent patient.In this paper, we describe a case of an immunocompetent patient with cerebral nocardiosis. The onset was with loss of strength, paresthesia and focal epilepsy of the left arm. MRI showed on T2-weighted sequences a hyperintense central area of pus surrounded by a well-defined hypointense capsule and surrounding edema; on T1-weighted sequences a hypointense necrotic cavity with ring enhancement following administration of intravenous gadolinium. The patient underwent surgical excision of the abscess but culture from the specimen was negative. After 40 days of empirical antimicrobial therapy he developed neurological deterioration with focal epilepsy. A new MRI documented an enlargement of the hypointense lesion in the right frontal-parietal region. A second craniotomy with drainage of the abscess was performed; cultures yielded nocardia farcinica. Therapy with trimethoprim/sulfamethoxazole, amikacin and meropenem was given for 35 days, and clinical and radiological improvement was observed. Home therapy was done with oral trimethoprim/sulfamethoxazole. Currently, 5 months from the second surgery, the patient can walk with support and no new episodes of epilepsy occurred. Side effects were absent from therapy. The MRI appearance of the brain lesion has improved, with a decrease in size, surrounding edema and ring enhancement.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
9/44. eikenella corrodens brain abscess after repeated periodontal manipulations cured with imipenem and neurosurgery.eikenella corrodens is a facultatively anaerobic gram-negative rod that colonizes the oral cavity and very rarely produces central nervous system (CNS) infections. frontal lobe abscesses are occasionally associated with a dental source of infection. We report a case of an adult man with overzealous dental cleaning habits who developed a right frontal brain abscess caused by E. corrodens. He underwent neurosurgical drainage of the pus and was successfully treated with imipenem 4 g/i.v./day for 4 weeks with no complications. Repeated periodontal trauma could explain the Eikenella brain abscess in this case.- - - - - - - - - - ranking = 2.5135861335534keywords = oral cavity, cavity (Clic here for more details about this article) |
10/44. gemella morbillorum deep brain abscess successfully treated with combined stereotactic, medical, and imaging approach.A rare case of brain abscess due to gemella morbillorum, a normal inhabitant of the oral cavity, is presented. The aim of this report is to draw the attention of radiology literature readers to this little known pathogen, which caused a potentially life-threatening condition in an immunocompetent young man, and to emphasise the usefulness of a combined stereotactic, medical, and imaging approach to deep-located brain abscesses.- - - - - - - - - - ranking = 2.5135861335534keywords = oral cavity, cavity (Clic here for more details about this article) |
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