Hyperbaric oxygen for intracranial abscess.

The term "intracranial abscess" (ICA) includes cerebral abscess, subdural empyema, and epidural empyema, which share many diagnostic and therapeutic similarities and, frequently, very similar etiologies. Infection may occur and spread from a contiguous infection such as sinusitis, otitis, mastoiditis, or dental infection; hematogenous seeding; or cranial trauma. In view of the high morbidity and mortality of ICA and the fact that hyperbaric oxygen therapy (HBO2) is relatively non-invasive and carries a low complication rate, the risk-benefit ratio favors adjunct use of HBO2 therapy in selected patients with intracranial abscess.

Nocardial spinal epidural abscess with lumbar disc herniation: A case report and review of literature.

RATIONALE: Nocardial spinal epidural abscess is rare. The diagnosis is often difficult to make and, if delayed, poses a high risk of long-term disability. Nocardial spinal epidural abscess with severe lumbar disc herniation has not previously been reported. PATIENT CONCERNS: A 50-year-old man presented with progressive lumbago and leg pain for 6 weeks after receiving acupuncture therapy, and then the patient suddenly occurred urine retention after walking. DIAGNOSES: Clinical examination revealed sign of cauda equina syndrome. Magnetic resonance imaging (MRI) revealed a Lumbar(L)4 to L5 disc herniation, L3 to Sacrum(S)1 epidural abscess, and L2 to S1 paravertebral abscess. The causative organism was Nocardia farcinica. INTERVENTIONS: An urgent paravertebral abscess debridement and right L4 to L5 laminectomy were performed. Simultaneously, the disc tissue protruding into the spinal canal was removed, as well as irrigation and drainage. And antimicrobial treatment was continued for 12 months. OUTCOMES: Fortunately, the patient was able to walk with a cane and urinate autonomously without a catheter, although this remained difficult 7 days after surgery. After 1 year of treatment, the patient has recovered completely and returned to work. LESSONS: Nocardial spinal epidural abscess with severe lumbar disc herniation is extremely rare. Pain from spinal degenerative diseases often masks the early symptoms of spinal infection. It's worth noting that invasive treatment of spine is a way of causing spinal nocardial infection.

Hyperbaric oxygen therapy (HBO) for the treatment of an epidural abscess in the posterior fossa in an 8-month-old infant.

Epidural abscesses in children are extremely rare, especially in the posterior fossa. In some cases antibiotic therapy and surgical drainage are insufficient for complete healing. We present the case of an 8-month-old boy who developed an epidural abscess in the posterior fossa after repeated surgical procedures for retrocerebellar arachnoid cysts and hydrocephalus. We decided to use adjuvant hyperbaric oxygen therapy (HBO) to avoid removal of the bone and the existing ventriculoperitoneal shunt. In this way osteomyelitis, potentially leading to bone removal and shunt infection, could be prevented. HBO is a relatively safe, noninvasive and cost-effective therapy to improve healing of chronic and deep-seated wound infections. To our knowledge HBO has never been used before in such a young child in neurosurgery. Multidisciplinary management is recommended to optimize treatment.

Successful treatment of extended epidural abscess and long segment osteomyelitis: a case report and review of the literature.

BACKGROUND: Spinal osteomyelitis and epidural abscess are complicated medical conditions. Diagnosis is often delayed because of cormorbidity. The time of instrumentation is still controversial. However, there is no doubting the indication of spinal hardware implantation when spinal fusion is needed. Long segment osteomyelitis and extended epidural abscess are rare. The treatment is challenging for neurosurgeons. We report a case of extended epidural abscesses and long segments of osteomyelitis. METHODS: One-stage meticulous debridement, anterior cervical corpectomies, and spinal fusion with mesh cage and titanium plate were performed on the patient. Hyperbaric oxygenation and 6 weeks of intravenous antibiotics were prescribed as adjuvant therapy. RESULTS: Both clinical presentations and imaging studies showed a good response to the treatment. The patient returned to his life 3 months later. CONCLUSIONS: This case illustrates that spinal instrumentation is not an absolute contraindication in the presence of epidural abscesses and vertebral osteomyelitis. Combined surgical debridement at a critical level, with adjuvant antibiotics and hyperbaric oxygenation, is a safe and effective therapy in those with neurologic deficits, spinal instability, and extended epidural abscess.

Successful treatment of cervical spinal epidural abscess by combined hyperbaric oxygenation.

A 49-year-old man underwent hyperbaric oxygen (HBO) therapy for the treatment of primary spinal epidural abscess. Although the epidural abscess was initially treated with antibiotic (cefozopran) for 5 days, he subsequently developed motor weakness, paresthesia and urinary retention. MRI demonstrated spinal cord compression at the C1-C4 level. HBO therapy was added to the antibiotic regimen, and three days later we found clinical evidence of a response to treatment. Neurological symptoms were relieved 13 days after HBO therapy. This case suggests that HBO therapy is an effective therapeutic adjunct for the treatment of spinal epidural abscess.