Search Results (7)

Background: Post-traumatic pseudomeningoceles are common findings after a brachial or lumbar plexus trauma, in particular after nerve root avulsion. Unlike meningoceles, pseudomeningoceles are CSF full-filled cysts confined by the paraspinous soft tissue, along the normal nerve course, in communication with the spinal subarachnoid spaces. Normally no more than a radiological finding at MRI, in rare instances they might be symptomatic due to their size or might constitute an obstacle during a reconstructive surgery. Methods: A review of the literature was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in a time span ranging from November 1972 to May 2024. A total of five articles were found meeting the inclusion criteria. A case report at our institution was added to the case history. Results: A 30-year-old man with complete right brachial plexus nerve roots avulsion and a voluminous pseudomeningocele at the C6-C7 level after a motorcycle incident in January 2023. The pseudomeningocele covered the entirety of the injured brachial plexus. Pre-operative external lumbar drainage was utilized to prevent relapse or worsening of the already existing cerebral spinal fluid collection, with good results at 6 months. The full case report is reported in detail. Conclusions: To date, no clear guidelines about the management of post-traumatic pseudomeningoceles are reported in the literature. The lack of symptoms or signs related to them does not usually require any surgical intervention. If not, a possible management strategy with the use of an external lumbar drainage is proposed, a solution already in use in other surgical contexts with successful results in preventing CSF fistula or its relapse. Full article

Background/Objectives: Postoperative cerebrospinal fluid (CSF) fistulas remain a significant concern in spinal neurosurgery, particularly following dural closure. The incidence of dural tears during spinal surgery is estimated between 1.6% and 10%. While direct suturing remains the gold standard, it has a failure rate of 5–10%. Various materials and techniques have been used to enhance dural closure. This study aims to assess the effectiveness of non-penetrating titanium clips (AnastoClip^®) for dural closure in intradural spinal lesion surgeries. Methods: A prospective analysis was conducted on 272 patients who were operated on for intradural spinal lesions from August 2017 to December 2023. Dural closure was performed using non-penetrating titanium clips with sealant, and, in select cases, autologous grafts. Postoperative care included early mobilization and routine MRI to assess outcomes. A comparative analysis was performed with a cohort of 81 patients treated with traditional sutures. Results: Among the 272 patients, postoperative CSF leaks occurred in 32 cases (11.76%), requiring various management approaches. Thirteen cases required surgical revision, while others resolved with external lumbar drainage or fluid aspiration. Compared to the suture group, which had a fistula rate of 23.46%, the titanium clip group had a significantly lower fistula rate. Logistic regression analysis did not find statistically significant associations between fistula risk and clinical factors. Conclusions: Non-penetrating titanium clips provide an effective alternative to sutures for dural closure, reducing CSF leak rates. They preserve dural integrity, reduce operative time, and avoid imaging artifacts, making them a viable advancement in spinal surgery with outcomes comparable to, or better than, traditional techniques. Full article

Purpose: A nomograph model of predicting the risk of post-operative central nervous system infection (PCNSI) after craniocerebral surgery was established and validated. Methods: The clinical medical records of patients after cranial surgery in Renmin Hospital of Wuhan University from January 2020 to September 2022 were collected, of whom 998 patients admitted to Shouyi Hospital District were used as the training set and 866 patients admitted to Guanggu Hospital District were used as the validation set. Lasso regression was applied to screen the independent variables in the training set, and the model was externally validated in the validation set. Results: A total of 1864 patients after craniocerebral surgery were included in this study, of whom 219 (11.75%) had PCNSI. Multivariate logistic regression analysis showed that age > 70 years, a previous history of diabetes, emergency operation, an operation time ≥ 4 h, insertion of a lumbar cistern drainage tube ≥ 72 h, insertion of an intracranial drainage tube ≥ 72 h, intraoperative blood loss ≥ 400 mL, complicated with shock, postoperative albumin ≤ 30 g/L, and an ICU length of stay ≥ 3 days were independent risk factors for PCNSI. The area under the curve (AUC) of the training set was 0.816 (95% confidence interval (95%CI), 0.773–0.859, and the AUC of the validation set was 0.760 (95%CI, 0.715–0.805). The calibration curves of the training set and the validation set showed p-values of 0.439 and 0.561, respectively, with the Hosmer–Lemeshow test. The analysis of the clinical decision curve showed that the nomograph model had high clinical application value. Conclusion: The nomograph model constructed in this study to predict the risk of PCNSI after craniocerebral surgery has a good predictive ability. Full article

Low- or very-low-pressure hydrocephalus is a serious and rare phenomenon, which is becoming better known since it was first described in 1994 by Pang and Altschuler. Forced drainage at negative pressures can, in most cases, restore the ventricles to their original size, thus achieving neurological recovery. We present six new cases that suffered this syndrome from 2015 to 2020: two of them after medulloblastoma surgery; a third one as a consequence of a severe head trauma that required bifrontal craniectomy; another one after craniopharyngioma surgery; a fifth one with leptomeningeal glioneuronal tumor; and, finally, a patient carrier a shunt for normotensive hydrocephalus diagnosed ten years before. At the moment of development of this condition, four of them had mid-low-pressure cerebrospinal fluid (CSF) shunts. Four patients required cerebrospinal fluid (CSF) drainage at negative pressures oscillating from zero to −15 mmHg by external ventricular drainage until ventricular size normalized, followed by the placement of a new definitive low-pressure shunt, one of them to the right atrium. The duration of drainage in negative pressures through external ventricular drainage (EVD) ranged from 10 to 40 days with concomitant intracranial pressure monitoring at the neurointensive care unit. Approximately 200 cases of this syndrome have been described in the literature. The causes are varied and superimposable to those of high-pressure hydrocephalus. Neurological impairment is due to ventricular size and not to pressure values. Subzero drainage is still the most commonly used method, but other treatments have been described, such as neck wrapping, ventriculostomy of the third ventricle, and lumbar blood patches when associated with lumbar puncture. Its pathophysiology is not clear, although it seems to involve changes in the permeability and viscoelasticity of the brain parenchyma together with an imbalance in CSF circulation in the craniospinal subarachnoid space. Full article

External ventricular drainage is often considered a life-saving treatment in acute hydrocephalus. Given the large number of discussion points, the ideal management of EVD has not been completely clarified. The objective of this study was to review the most relevant scientific evidence about the management of EVD in its main clinical scenarios. We reviewed the most recent and relevant articles about indications, timing, management, and complications of EVD in neurocritical care, with particular interest in patients with subarachnoid hemorrhage (SAH), severe traumatic brain injury (TBI), and intraventricular hemorrhage (IVH) using the following keywords alone or matching with one another: intracranial pressure, subarachnoid hemorrhage, traumatic brain injury, intraventricular hemorrhage, external ventricular drainage, cerebrospinal shunt, intracranial pressure monitoring, and ventriculoperitoneal shunt. In the management of EVD in SAH, the intermittent drainage strategy is burdened with an elevated risk of complications (e.g., clogged catheter, hemorrhage, and need for replacement). There seems to be more ventriculoperitoneal shunt dependency in rapid weaning approach-managed patients than in those treated with the gradual weaning approach. Although there is no evidence in favor of either strategy, it is conventionally accepted to adopt a continuous drainage approach in TBI patients. Less scientific evidence is available in the literature regarding the management of EVD in patients with severe TBI and intraparenchymal/intraventricular hemorrhage. EVD placement is a necessary treatment in several clinical scenarios. However, further randomized clinical trials are needed to clarify precisely how EVD should be managed in different clinical scenarios. Full article

There is little evidence on the role of prior infection in patients with external ventricular drains (EVDs) and lumbar drains (LDs). In this study, our aim is to investigate whether previous bacteremia is a risk factor for cerebrospinal fluid drain infection (CSFDI) in patients with EVDs and LDs and to describe the microorganisms implicated. We designed a retrospective, single-center cohort study. We recorded patients’ demographic and clinical characteristics, as well as microbiology laboratory data. We used non-parametric statistical methods to identify possible risk factors for CSFDI. We found 799 neurosurgical admissions during the study period, 70 of which fulfilled the inclusion criteria. Acinetobacter baumannii was the most frequent single pathogen isolated in the cerebrospinal fluid (CSF). Acinetobacter baumannii bacteremia was more common in patients with Acinetobacter baumannii CSFDI (p = 0.01). The distribution of the pathogens in the CSF differed from that of the pathogens isolated in blood (p = 0.001). In the univariate analysis, prior bacteremia was more common in patients with CSFDI (p = 0.027), but, in the multivariate model, prior bacteremia was not identified as an independent risk factor (OR = 0.456, CI: 0.138–1.512, p = 0.2). In an ICU population, the most frequently isolated pathogens were Gram-negative Enterobacteriaceae and Acinetobacter baumannii. Previous bacteremia was significantly more probable among patients with EVDs or LDs who developed a CSFDI, and its role warrants further investigation. Full article

Background: Automated cerebrospinal fluid (CSF) drainage systems allow for the mobilization of patients with an external CSF drain. The aim of this study is to describe the implementation of an automated CSF drainage system in neurosurgical patients with external CSF drains. Methods: A feasibility study was performed using an automated CSF drainage system (LiquoGuard^®7, Möller Medical GmbH, Fulda, Germany) in adult neurosurgical patients treated with external lumbar or external ventricular drains between December 2017 and June 2020. Limited mobilization was allowed—patients were allowed to adjust their inclined beds, sit in chairs and walk under the supervision of a nurse or physical therapist. The primary outcome was the number of prematurely terminated drainage sessions. Results: Twenty-three patients were included. Drainage was terminated prematurely in eight (35%) patients. In three (13%) of these patients, drainage was terminated due to signs of hydrocephalus. Pressure-controlled drainage in patients with external lumbar drains (ELD) showed inaccurate pressure curves, which was solved by using volume-controlled drainage in ELD patients. Conclusion: The implementation of an automated CSF drainage system (LiquoGuard^®7) for CSF drainage allows for early mobilization in a subset of patients with external CSF drains. External lumbar drains require volume-based drainage rather than differential pressure-dependent drainage. Full article