Acute intracranial hemorrhage during the installation of the LICOX microdialysis system: A case report.

Neuro-monitoring is widely employed for the evaluation of intubated patients in the intensive care unit with stroke, severe head trauma, subarachnoid hemorrhage and/or hepatic encephalopathy. The present study reports the case of a patient with acute intracranial hemorrhage following the insertion of neuromonitoring catheters, which required surgical management. The patient was a 14-year-old male who sustained a severe traumatic brain injury and underwent a right-sided hemicraniectomy. During the installation of the neuromonitoring catheters, an acute hemorrhage was noted with a rapidly elevating intracranial pressure. A craniotomy was performed to identify and coagulate the injured cortical vessel. As demonstrated herein, the thorough evaluation of the clotting profile of the patient, a meticulous surgical technique and obtaining a post-insertion computed tomography scan may minimize the risk of any neuromonitoring-associated hemorrhagic complications.

Comparison of surgical outcomes between primary and secondary brain abscess.

Brain abscess (BA) constitutes 1-8% of intra-cerebral tumors, and thus the present study aimed to compare the surgical outcomes of patients with primary and secondary BA. The present retrospective study examined 32 of cases BA who underwent surgery in a local institution between February, 2013 and December, 2023. All patients received intravenous antibiotic therapy according to the antibiogram for antimicrobial susceptibility. In total, 32 patients were separated into two groups as follows: Group A (16 patients, 50%) with primary abscess and group B (16 patients, 50%) with secondary abscess. Of the 32 patients included in the study, 23 (71.8%) were males, and the median age was 55.3 years. On the whole, the present study demonstrates that a multidisciplinary approach involving a combination of often multiple surgical procedures and prolonged antibiotic medication may improve the functional outcome if the underlying pathology allows for a functional outcome.

Bone graft absorption complication following cranioplasty: A retrospective institutional study.

The aim of the present retrospective study was to confer the factors that are related to bone graft absorption and affect the outcomes of patients following cranioplasty (CPL). The present retrospective study includes cases of patients that underwent CPL between February, 2013 and December, 2022. All participants had a follow-up period of 1 to 10 years from the day of discharge from the hospital. In total, 116 (62.3%) of the 186 patients that underwent decompressive craniectomy (DC) were enrolled in the present study for CPL. A total of 109 (93.9%) patients were included in group A, and 7 (6.0%) patients were included in group B. On the whole, the results of the present study suggest that a CPL after 2.5-7.7 months of DC increases the possibility of bone absorption.

Investigation of risk factors for external ventricular drainage­associated central nervous system infections in patients undergoing neurosurgery.

Meningitis/ventriculitis (MV) is an illness which can occur as a complication following neurosurgical procedures. Devices such as an external ventricular drain (EVD) are also related to considerable complications, such as infections. The present study examined the risk factors associated with central nervous system (CNS) infections associated with the external ventricle drainage system. The present retrospective study included all patients hospitalized between April, 2011 and August, 2018 who had been receiving therapy with EVD for developed hydrocephalus. A total of 48 out of 65 patients were classified into two groups as follows: Patients without MV (group A) and patients who developed MV (group B). The durations of hospital stay and intensive care unit (ICU) stay were significantly lower in group A (32.4±24 and 21.1±11 days, respectively) compared to group B (54.7±37 and 42±24 days, respectively) (P=0.027 and P=0.001, respectively). The Acute Physiological and Chronic Health Evaluation II (APACHE II) score and EVD distance from the wound exit side to the burr hole were significantly lower in the survivors compared to the non-survivors (17.5±6 and 15.4±4 vs. 22.5±6 and 39.8±38, respectively). Receiver operating characteristic analysis revealed that the APACHE II score with an area under the curve [(AUC) of 0.677, P=0.044, and 95% confidence interval (CI) of (0.516-0.839)] and a cut-off value of 14 could predict mortality with a sensitivity of 100% and a specificity of 71%; the EVD distance from the wound exit side from the burr hole with an AUC of 0.694 (P=0.028), 95% CI of 0.521-0.866 and a cut-off value of 11.5 mm could predict mortality with a sensitivity of 88% and a specificity of 83%. On the whole, the present study demonstrates that the EVD-related distance from the wound exit side of the burr hole can predict poor outcomes due to CNS infections in patients undergoing neurosurgery.

Bundle of measures for external cerebral ventricular drainage-associated ventriculitis.

OBJECTIVE: To assess the prevalence and outcome of external cerebral ventricular drainage-associated ventriculitis in neurocritical patients before and after the implementation of a bundle of external cerebral ventricular drainage-associated ventriculitis control measures. DESIGN: Clinical prospective case series. SETTING: University Hospital of Larissa, Greece. PATIENTS: Consecutive patients were recruited from the ICU of the hospital. Patient inclusion criteria included presence of external ventricular drainage and ICU stay more than 48 hours. INTERVENTION: The bundle of external cerebral ventricular drainage-associated ventriculitis control measures included 1) reeducation of ICU personnel on issues of infection control related to external cerebral ventricular drainage, 2) meticulous intraventricular catheter handling, 3) cerebrospinal fluid sampling only when clinically necessary, and 4) routine replacement of the drainage catheter on the seventh drainage day if the catheter was still necessary. The bundle was applied after an initial period (preintervention) where standard policy for external cerebral ventricular drainage-associated ventriculitis was established. MEASUREMENTS: External cerebral ventricular drainage-associated ventriculitis prevalence, external cerebral ventricular drainage-associated ventriculitis events per 1,000 drainage days (drain-associated infection rate), length of ICU stay, Glasgow Outcome Scale at 6 months, and risk factors for external cerebral ventricular drainage-associated ventriculitis. MAIN RESULTS: Eighty-two patients entered the study in the preintervention period and 57 patients during the intervention period. During the preintervention and intervention period, external cerebral ventricular drainage-associated ventriculitis prevalence was 28% and 10.5% (p = 0.02) and drain-associated infection rate was 18 and 7.1, respectively (p = 0.0001); mean (95% CI) length of ICU stay in patients who presented external cerebral ventricular drainage-associated ventriculitis was 44.4 days (36.4-52.4 d), whereas mean (95% CI) length of ICU stay in patients who did not was 20 days (16.9-23.2 d) (p < 0.001). Furthermore, the length of ICU stay was associated with length of drainage (p = 0.0001). Therefore, the presence of external cerebral ventricular drainage-associated ventriculitis and the length of drainage were the only variables associated with a prolonged ICU stay. Unfavorable outcome in Glasgow Outcome Scale at 6 months was not associated with the presence of external cerebral ventricular drainage-associated ventriculitis (p = 0.5). No significant differences were found when Glasgow Outcome Scale was analyzed according to the two study periods. CONCLUSIONS: The implementation of a bundle of measures for external cerebral ventricular drainage-associated ventriculitis control was associated with significantly decreased postintervention prevalence of the infection.