Robotic cochlear implantation in post-meningitis ossified cochlea.

AIM: To report the experience of an image-guided and navigation-based robot arm as an assistive surgical tool for cochlear implantation in a case with a labyrinthitis ossificans. PATIENT: A 55-years-old man with a history of childhood meningitis whose hearing deteriorated progressively to bilateral profound sensorineural hearing loss. INTERVENTION: Robotic Assisted Cochlear Implant Surgery (RACIS) with a straight flexible lateral wall electrode. PRIMARY OUTCOME MEASURES: Electrode cochlear insertion depth with RACIS with facial recess approach and autonomous inner ear access with full electrode insertion of a flexible straight cochlear implant array. CONCLUSIONS: Intra cochlear ossifications pose a challenge for entering the cochlea and full-length insertion of a cochlear implant. RACIS has shown that computations of radiological images combined with navigation-assisted robot arm drilling can provide efficient access to the inner ear.

Management of a rare case of intraventricular ruptured dermoid cyst and chemical meningitis.

INTRODUCTION: Intraventricular dermoid cyst are very rare benign tumour. Due to benign nature, it may go un-noticed for years and might present with sudden rupture. Ruptured cyst can cause chemical meningitis, hydrocephalus, seizures etc. Due to lack of data, there are no defined guidelines about its management. We are reporting an interesting case of ruptured intraventricular dermoid cyst and chemical meningitis, who was managed successfully and will review the literature. CASE REPORT: A 48 years male patient was brought with complaint of sudden mental deterioration, irritability, headache, vomiting for 3 days. He had history of seizures for 1 year. On examination, his higher mental functions were deteriorated, had neck rigidity and left lower limb weakness. CT/MRI brain confirmed diagnosis of right frontal horn ruptured dermoid cyst with scattered fat droplets, hydrocephalus and ventriculitis. Excision of cyst was done via right trans-sulcal (superior frontal sulcus) approach. Patient recovered well. DISCUSSION: Intraventricular dermoid cyst are a rare benign lesion. Due to potential of rupture, it must be surgically treated. Steroids should be used to treat chemical meningitis. Various individual case reports have shown good outcome after surgical management. CONCLUSION: We recommend early surgery, thorough ventricular wash with ringer lactate, post-operative extraventricular drain and steroid cover to manage ruptured cyst and chemical meningitis.

Risk of meningitis after posterior fossa decompression with duraplasty using different graft types in patients with Chiari malformation type I and syringomyelia: a systematic review and meta-analysis.

Several complications have been reported after the use of grafts for duraplasty following posterior fossa decompression for the treatment of Chiari malformation type I. This study aims to investigate the rate of meningitis after posterior fossa decompression using different types of grafts in patients with Chiari malformation type I and associated syringomyelia. The search was conducted using multiple databases, including PubMed, Scopus, Web of Science, and Embase. Data on the rate of meningitis, syrinx change, and rate of reoperation were extracted and investigated. Quality of evidence was assessed using the Newcastle-Ottawa scale. Nineteen studies were included in the final meta-analysis, encompassing 1404 patients and investigating autografts, synthetic grafts, allografts, and xenografts (bovine collagen, bovine pericardium, and pig pericardium). Autografts were associated with the lowest rate of meningitis (1%) compared to allografts, synthetic grafts, and xenografts (2%, 5%, and 8% respectively). Autografts were also associated with the lowest rate of reoperation followed by xenografts, allografts, and synthetic grafts (4%, 5%, 9%, and 10% respectively). On the other hand, allografts were associated with the highest rate of syrinx improvement (83%) in comparison to autografts and synthetic grafts (77%, and 79% respectively). Autografts were associated with the lowest meningitis, reoperation, and syrinx improvement rates. Furthermore, synthetic grafts were associated with the highest reoperation and xenografts with the highest rate of meningitis, whereas allografts were associated with the best syrinx improvement rate and second-best meningitis rate. Future studies comparing autografts and allografts are warranted to determine which carries the best clinical outcome.

Bordetella bronchiseptica: a rare cause of meningitis.

BACKGROUND: Bordetella bronchiseptica is a gram-negative, obligate aerobic coccobacillus known to cause disease in domesticated animals and pets. In humans, B. bronchiseptica commonly leads to respiratory infections like pneumonia or bronchitis, and animal contact usually precedes the onset of symptoms. CASE PRESENTATION: We report a case of post-traumatic B. bronchiseptica meningitis without recent surgery in the setting of immunosuppression with a monoclonal antibody. Our case concerns a 77-year-old male with ulcerative colitis on infliximab who sustained a mechanical fall and developed a traumatic cerebrospinal fluid leak complicated by meningitis. He received meropenem then ceftazidime during his hospital course, and temporary neurosurgical drain placement was required. His clinical condition improved, and he was discharged at his baseline neurological status. CONCLUSIONS: B. bronchiseptica is an unusual cause of meningitis that may warrant consideration in immunocompromised hosts with known or suspected animal exposures. To better characterize this rare cause of meningitis, we performed a systematic literature review and summarized all previously reported cases.

[Multiloculated Hydrocephalus Complicated by Meningitis and Ventriculitis Treated with Staged Fenestration:A Case Report].

Multiloculated hydrocephalus following severe meningitis with ventriculitis is often therapeutically challenging. Neonatal meningitis is commonly associated with ventricular inflammation, and approximately 30% of patients show septum formation. Although placement of a single ventriculoperitoneal shunt system could serve as optimal treatment for a multiloculated cerebrospinal cavity that is converted into a single chamber, multiple devices are often required for disease stability. We report a case of multiloculated hydrocephalus that occurred after meningitis in a patient who was successfully treated with a single shunt system using staged multimodality treatments.

Outcome following postneurosurgical Acinetobacter meningitis: an institutional experience of 72 cases.

OBJECTIVE: The authors aimed to evaluate the antimicrobial susceptibility pattern of Acinetobacter isolates responsible for nosocomial meningitis/ventriculitis in the neurosurgical ICU. The authors also sought to identify the risk factors for mortality following Acinetobacter meningitis/ventriculitis. METHODS: This was a retrospective study of 72 patients admitted to the neurosurgical ICU between January 2014 and December 2018 with clinical and microbiological diagnosis of nosocomial postneurosurgical Acinetobacter baumanii meningitis/ventriculitis. Electronic medical data on clinical characteristics, underlying pathology, CSF cytology, antibiotic susceptibilities, and mortality were recorded. To evaluate the outcome following nosocomial postneurosurgical Acinetobacter meningitis/ventriculitis, patients were followed up until discharge or death in the hospital. Kaplan-Meier survival analysis and multivariable Cox proportional hazards models were used to compute factors affecting survival. RESULTS: The study population was divided into two groups depending on the final outcome of whether the patient died or survived. Forty-three patients (59.7%) were included in the survivor group and 29 patients (40.3%) were included in the nonsurvivor group. Total in-hospital mortality due to Acinetobacter meningitis/ventriculitis was 40.3% (29 cases), with a 14-day mortality of 15.3% and a 30-day mortality of 25%. The 43 (59.7%) patients who survived had a mean length of hospital stay of 44 ± 4 days with a median Glasgow Outcome Scale-Extended score at discharge of 6. On univariate analysis, age > 40 years (p = 0.078), admission Glasgow Coma Scale (GCS) score ≤ 8 (p = 0.003), presence of septic shock (p = 0.011), presence of external ventricular drain (EVD) (p = 0.03), CSF white blood cell (WBC) count > 200 cells/mm3 (p = 0.084), and comorbidities (diabetes, p = 0.036; hypertension, p = 0.01) were associated with poor outcome. Carbapenem resistance was not a risk factor for mortality. According to a multivariable Cox proportional hazards model, age cutoff of 40 years (p = 0.016, HR 3.21), GCS score cutoff of 8 (p = 0.006, HR 0.29), CSF WBC count > 200 cells/mm3 (p = 0.01, HR 2.76), presence of EVD (p = 0.001, HR 5.42), and comorbidities (p = 0.017, HR 2.8) were found to be significant risk factors for mortality. CONCLUSIONS: This study is the largest case series reported to date of postneurosurgical Acinetobacter meningitis/ventriculitis. In-hospital mortality due to Acinetobacter meningitis/ventriculitis was high. Age older than 40 years, GCS score less than 8, presence of EVD, raised CSF WBC count, and presence of comorbidities were risk factors for mortality.

Long tunnel external ventricular drain: an adjunct in the management of patients with infection associated hydrocephalus.

Objective: To evaluate the safety and efficacy of long tunnelled external ventricular drains (LTEVD) as a temporizing measure in patients with ventriculitis/meningitis requiring cerebrospinal fluid (CSF) diversion in whom immediate shunt surgery is not feasible.Methods: A retrospective review of the records of 15 patients with ventriculitis/meningitis, in whom an LTEVD was inserted, was performed to evaluate its safety, new onset CSF infection and need for permanent CSF diversion.Results: 15 patients with ventriculitis/meningitis had 16 LTEVDs placed between May 2006 and December 2016. There were 10 males and 5 females, their mean age being 16.5 years (range, 8 months-50 years). The mean duration of CSF drainage was 15.6 days (range, 4 to 44 days). Of the 16 LTEVDs that were inserted, two (13.3% - one CSF infection and one wound infection) developed new infection after 44 and 17 days of continuous CSF drainage respectively. The LTEVDs were removed and permanent CSF diversion procedures were performed in 10 patients during the same admission and in one patient later. At a mean follow up of 11.6 months (range 2-40 months), 8 of the 11 patients who underwent a permanent CSF diversion procedure had no clinical features of meningitis/ventriculitis.Conclusion: LTEVDs are an effective method of temporary CSF diversion in patients requiring the same for more than 5 days. These drains have a low infection rate when placed up to four weeks making them a safe and efficacious adjunct in management of ventriculitis/meningitis associated hydrocephalus.

Rapidly progressive fatal idiopathic hypertrophic pachymeningitis with brainstem involvement in a child.

BACKGROUND: Hypertrophic pachymeningitis (HP) is a rare disorder characterized by diffuse thickening of the dura mater with resultant neurologic deficits. HP develops secondary to various conditions or idiopathically usually in adults but rarely in children. CASE REPORT: We describe a 3-year-old female child with idiopathic HP. Her HP involved the entire central nervous system with progression into the brainstem. The lesion responded poorly to pulsed steroids or any immunosuppressants. The brainstem lesion grew rapidly and formed various nodules that ultimately resulted in brain death. This is the first fatal case of HP in a child.

[A Case of Hypertrophic Pachymeningitis with Symptomatic Venous Congestion due to Sinus Stenosis].

We report a patient with hypertrophic pachymeningitis and symptomatic stenosis of the superior sagittal sinus. A 71-year-old man presented with right hemiparesis, sensory-dominant aphasia, and right hemispatial neglect that had been worsening over 2 weeks. Computed tomography showed isodense crescent-shaped lesions deforming the surface of the left cerebral hemisphere, mimicking a subdural hematoma with atypical perifocal edema in the left parietal lobe. Magnetic resonance imaging showed diffuse thickening of the dura mater with contrast enhancement of his left cerebral hemisphere. Histopathological examination of the dural specimen obtained by burr-hole surgery revealed mononuclear inflammatory cell infiltration, and he was diagnosed with hypertrophic pachymeningitis. Dynamic cerebral angiography showed superior sagittal sinus stenosis with reduced venous flow through the left parietal lobe. Administration of high-dose steroid therapy led to neurological improvement. In the case of a subdural mass with atypical parenchymal edema such as a chronic subdural hematoma, other etiology should be taken into consideration.

Association Between Vancomycin Blood Brain Barrier Penetration and Clinical Response in Postsurgical Meningitis.

PURPOSE: This study investigated the association between vancomycin blood brain barrier penetration and clinical response in patients with postsurgical meningitis. METHODS: Adult patients with postsurgical meningitis were recruited. Eligible patients received vancomycin 500 mg every 6 h for at least 5 days. On day 3 or 4, cerebrospinal fluid (CSF) and simultaneous serum samples were obtained to determine CSF minimum concentrations (Cmin), serum Cmin and CSF to serum Cmin ratio. RESULTS: Twenty-two patients (14 men and 8 women; mean age of 52.6± 12.1 years) were recruited. The vancomycin Cmin was 3.63 ± 1.64 mg/L in CSF and 13.38 ± 5.36 mg/L in serum, with the CSF to serum Cmin ratio of 0.291 ± 0.118. The Cmin in serum and in CSF showed a significant correlation (p=0.005, r =0.575). The vancomycin CSF Cmin had a significant correlation with the decline of white blood cell counts (WBCs) in CSF (p=0.003, r =0.609). CSF Cmin, serum Cmin and CSF to serum Cmin ratio all showed no significant correlation with clinical response (p=0.335, 0.100, 0.679, respectively). CONCLUSIONS: There was a positive correlation between serum Cmin and CSF Cmin. However, only CSF Cmin is positively correlated with WBCs improvement in CSF. All other parameters such as serum Cmin, CSF Cmin and CSF to serum Cmin ratio had no correlation with clinical response. This article is open to POST-PUBLICATION REVIEW. Registered readers (see "For Readers") may comment by clicking on ABSTRACT on the issue's contents page.

[A Case of Hydrocephalus in Listeria Meningitis Treated by Endoscopic Third Ventriculostomy].

A 69-year-old woman presented with anorexia, fever, and vomiting. The patient was not a compromised host. She was finally diagnosed with Listeria meningitis and treated with ampicillin and gentamicin. However, her condition worsened over time. Non-contrast head CT showed ventricular dilatation. As a result, continuous right ventricular drainage was performed. Non-contrast MRI revealed hydrocephalus due to stenosis of the fourth ventricle. She underwent endoscopic third ventriculostomy(ETV)to improve cerebrospinal fluid circulation. This procedure achieved a good result. The efficacy of ETV for post-infectious hydrocephalus has not been proven, but previous cases suggest that ETV would be effective in non-communicating hydrocephalus, even if it were a result of neuroinfection.

[CHRONIC OSTHEOMYELITIS OF THE FACIAL MIDDLE ZONE WITH SPREADING ON THE BONES OF CRANIAL BASE ON BACKGROUND OF NARCOTIC DEPENDENCE].

Own experience of treatment of a narcotic dependence patients, suffering osteomyelitis of jaws, was analyzed. In those patients, who have had exposed themselves towards toxic impact of narcotic substances (even after arrest of the consumption) for a long period of time, the inflammation spreading on the bones of facial middle zone and the skull base with occurrence of a life3threatening purulent3septic, including intracerebral, complications (cerebral аbscess, meningitis, sepsis) were observed. Additional division of cerebral abscess on open and closed forms for optimization of diagnosis of іntracranial complications was proposed.

Hypertrophic pachymeningitis.

BACKGROUND: Hypertrophic pachymeningitis (HP) is a rare clinical entity characterized by diffuse or localized fibrous thickening of the dura mater. It is well known but rare especially in pediatric population disease of differing origins. The primary (idiopathic) form is diagnosed after excluding other possible etiologies. Similar results from magnetic resonance imaging (MRI) for patients with hypertrophic pachymeningitis and meningiomas may make the diagnosis confusing. Additionally, making a proper diagnosis without histological sampling can be difficult in some cases. CASE DESCRIPTION: We present a case of an 18-year-old boy diagnosed with hypertrophic pachymeningitis in the area of the hypoglossal canal. The diagnosis was made after a 2-month history of hypoglossal nerve palsy and dysphagia preceded by a middle ear infection. The patient was treated surgically with suspicion of meningioma, but no evidence of a tumor was found during the operation. The postoperative period was uneventful. At the latest check-up, MRI revealed regression of all previously observed pathological changes.

Cerebrospinal fluid otorrhea and pseudomonal meningitis in a child with Mondini dysplasia: case report.

PURPOSE: Mondini dysplasia is a rare congenital inner ear malformation that presents with abnormal cochlear development with accompanied vestibular dilation and vestibular aqueduct enlargement. This dysfunctional anatomy provides the potential for sensorineural hearing deficits, cerebrospinal fluid leaks, and severe cases of recurrent meningitis. METHODS: We present the case of a child with Mondini dysplasia who presented with unilateral hearing loss and cerebrospinal fluid (CSF) otorrhea that was surgically repaired through a combined middle fossa/transmeatal middle ear approach to alleviate any recurrence of infection and cerebrospinal fluid otorrhea. RESULTS: Postoperatively, the patient remained neurologically stable without any further CSF leakage. CSF cultures revealed a Pseudomonas aeruginosa infection, a rare occurrence within the context of Mondini dysplasia. Retrograde bacterial spread from the external ear canal into the CSF space has been theorized as the possible pathogenesis of the resulting meningitis. The patient was successfully treated with intravenous antibiotics without any neurologic complications. CONCLUSIONS: Although Mondini dysplasia is a rare malformation, the life-threatening sequelae of meningitis that can result from the dysfunctional anatomy makes it a condition that requires elevated clinical vigilance, especially when considering children with hearing loss associated with recurrent meningitis, otorrhea, or rhinorrhea.

Recurrent meningitis secondary to a petrous apex meningocele.

This case report describes a patient who was found to have a cerebrospinal fluid (CSF) leak originating from the petrous apex. The patient initially presented with multiple bouts of meningitis. The patient was treated surgically via a middle cranial fossa approach but presented five years later with recurrent meningitis and was found to have an osseous defect of the petrous apex which was not recognized prior to the initial surgery.

Intracranial complications of chronic otitis media.

The objective of this study was to review our experience on intracranial complications (ICC) secondary to chronic otitis media (COM), and to investigate its clinical characteristics and treatment approaches. From January 1996 to December 2012, 17 patients with ICC secondary to COM were identified and included in this study, and were analyzed retrospectively. 13 out of these 17 cases (76.4 %) have cholesteatoma. The most common intracranial complication is brain abscesses (52.9 %), followed by meningitis (29.4 %), perisinus abscess (11.7 %), and epidural abscess (6 %). All patients underwent emergency mastoidectomy within the first 24 h after clear diagnosis. 7 patients underwent brain abscess drainage or abscess excision at the time of ear surgery. The mortality rates are 0 %. No recurrence was found in the 24-month follow-up period. Cholesteatoma was strongly associated with ICC. An early diagnosis and active surgical intervention in collaboration with proper antibiotic treatment is the key to cure.

[A case of repeated shunt malfunctions with eosinophilic meningitis caused by silicone allergy].

The ventricular-peritoneal shunt for hydrocephalus is a well-known and established method but is sometimes complicated by shunt malfunction due to several causes. Eosinophilic meningitis is a rare disease, but has occasionally been reported as a cause of shunt malfunction. Here, we report the case of a 74-year-old woman with repeated shunt malfunction and eosinophilic meningitis due to a silicone allergy. Originally, the patient received a ventricular-peritoneal shunt for normal pressure hydrocephalus secondary to subarachnoid hemorrhage. However, shunt malfunction was identified 6 weeks later, and the first shunt revision was performed using a new shunt system from a different company. Further evaluation to identify the cause of the shunt malfunction revealed no abnormal findings, except for eosinophilia in the serum and cerebrospinal fluid. A second shunt malfunction was identified 16 weeks after the first shunt revision. We therefore concluded that eosinophilic meningitis caused by a silicone allergy might be the real culprit and a second shunt revision was performed using a silicone "extracted" tube. Since then, the patient's course has been free from shunt malfunction. In this case, the serum and cerebrospinal fluid eosinophilia were useful markers for identifying the cause of repeated shunt malfunctions. The silicone "extracted" tube may be helpful for diagnosis and therapy.

Comparative study of lumboperitoneal shunt versus ventriculoperitoneal shunt in post meningitis communicating hydrocephalus in children.

BACKGROUND: Managing post meningitis hydrocephalus in children is a herculean task for the treating pediatric surgeon or neurosurgeon because of the morbidity associated with the disease per se and the complications of shunt surgery. By this study, the effectiveness of lumboperitoneal (LP) shunt and ventriculoperitoneal (VP) shunt in cases of post meningitis communicating hydrocephalus was assessed in children. MATERIALS AND METHODS: This was a retrospective analysis of the records of children admitted in our institute between December 2005 and March 2008. Only children with post meningitis communicating hydrocephalus who underwent either LP or VP with a minimum follow-up period of 36 months were included in the study. Children with non-communicating hydrocephalus or hydrocephalus due to another etiology were excluded. Investigations were included plain brain computed tomography scan, air encephalography and X-ray skull. Medium pressure Chabbra shunt with slit valves was used in all cases of VP and LP shunt. A comparative analysis of the outcome was carried out between the two groups. RESULTS: There were 66 males and 24 females (M: F 2.7:1. The average age at presentation was 40.3 months. LP shunt was performed in 37 while VP shunt in 53 cases Complication rate in the LP and VP shunt was 15% and 29% respectively with non-obstructed complications higher in VP group when compared to LP group. Obstructed complication rate was similar in both groups. CONCLUSION: Due to less morbidity and ease of placement, LP shunt can be an alternative to VP shunt in cases of communicating hydrocephalus in children, which has more non-obstructed complication rates as compared to LP shunt.

[Chronic hypertrophic pachymeningitis: 2 clinical cases are presented]. / Paquimeningitis hipertrófica crónica: presentación de 2 casos.

Chronic hypertrophic pachymeningitis is an inflammatory process of unknown aetiology characterised by a thickening of the dura mater causing pseudotumoural growth. Clinical manifestations are usually secondary to compression of adjacent neurological structures but may be also secondary to inflammatory processes. Diagnosis is mainly obtained by excluding infectious, neoplastic and autoimmune causes. Nowadays, steroid treatment is the most commonly used therapy. Two clinical cases of hypertrophic pachymeningitis are presented which were treated by surgery without any additional treatment and with good clinical and radiological development.

[External auditory canal osteoma resulting in cholesteatoma which is complicated with meningitis]. / Kolestatoma neden olan ve menenjit ile komplike olan dis kulak kanali osteomu.

Osteoma of external auditory canal is a unilateral benign tumor which usually presents with no symptoms. They only cause symptoms when cerumen collection or conduction type hearing loss occurs. They are the most common osseous lesions of the temporal bone. It very rarely presents with cholesteatoma. So far, no osteoma case concomitant with, cholesteatoma and meningitis has not been reported. In this article, we report an interesting case presenting with external auditory canal osteoma, cholestatoma and meningitis concomitantly who was treated successfully using the canal Wall-down mastoidectomy technique.