Common Options and Overlooked Alternative for Drainage of Inaccessible Presacral Abscess: A Case Report.

PURPOSE: To demonstrate options and alternative for drainage of inaccessible presacral abscess by the example of a rare clinical case of pyogenic spondylodiscitis, transsacraly drained under a combination of two interventional techniques - CT-guided bone biopsy and abscess drainage. MATERIALS AND METHODS: A 55-year-old patient with history of recurrent paravertebral abscesses previously treated with antibiotic therapy was referred to our institution experiencing lower back pain and weakness in both lower extremities. Computed tomography revealed pyogenic spondylodiscitis along with left facet joint destruction and presacral abscess located in ventral sacral surface. Due to inaccessible abscess location, it was decided to perform CT-guided percutaneous transsacral abscess drainage. An 8G bone marrow biopsy needle was used to penetrate the sacrum and create a path for drainage catheter placement. Using the Seldinger technique 8 Fr drainage catheter was inserted into abscess cavity. RESULTS: Neither early nor late procedure-related complications occurred. Sixteen days after drainage procedure, the catheter was withdrawn as patient's condition improved and the outflow of pus had reduced considerably. CONCLUSIONS: Despite being rarely used, CT fluoroscopy-guided transsacral drainage approach is considered to be minimally invasive and in some cases the only viable option for drainage of pyogenic spondilodiscitis of the lumbosacral junction.

Identification of the Distal Dural Ring and Definition of Paraclinoid Aneurysms According to Bony Landmarks on 3-Dimensional Computed Tomography Angiography: A Cadaveric and Radiological Study.

BACKGROUND: Determining if paraclinoid aneurysms are intradural or extradural is critical for surgical planning. OBJECTIVE: To create an easily reproducible diagnostic method based on bony anatomy that precisely locates the distal dural ring (DDR) to determine the position of paraclinoid aneurysms as intradural, transitional, or extradural. METHODS: Bilateral anatomic dissections of 10 cadaveric heads (20 sides) were performed to evaluate DDR anatomy. We observed a plane that reflects the position of the DDR passes through 4 bony landmarks: 1) The anterior clinoid-internal carotid artery intersection, 2) the optic strut, 3) the optico-carotid elevation, and 4) the base of the posterior clinoid process. This landmark-based plane can thus define the location of the DDR using 3-dimensional computed tomography angiography (CTA). This was confirmed in 27 surgical patients with intradural/transitional aneurysms and 7 patients with extradural aneurysms confirmed with magnetic resonance imaging (MRI). The DDR plane method easily classified aneurysm locations as intradural (above the DDR plane), extradural (below the DDR plane), or transitional (the DDR plane crosses the aneurysm). The aneurysm's location was subsequently confirmed intraoperatively or with MRI. RESULTS: The DDR plane method determined if paraclinoid aneurysms were intradural, transitional, or extradural in all 34 cases examined. The visibility of the anatomic features that define the DDR plane was also verified in 82% to 89% of CTA images from 100 patients. CONCLUSION: The DDR plane method provides a useful diagnostic tool to evaluate the position of the DDR and determine the anatomic location of paraclinoid aneurysms.

Intrathecal Baclofen Therapy for the Treatment of Spasticity in Lithuania.

Spasticity of cerebral or spinal origin severely impairs an individual's functional ability and quality of life. Intrathecal baclofen (ITB) therapy via an implantable pump is indicated for use in patients unresponsive to oral antispasmodics. ITB therapy improves the daily caring for and relief of painful spasms. In Lithuania, ITB therapy was introduced in clinical practice just recently. We share our experience of spasticity management with the ITB pump system in five patients at Vilnius University Hospital Santariskiu Klinikos. Four patients had spastic tetraplegia associated with cerebral palsy, and one patient developed spastic paraplegia after a spinal epidural abscess.

Timing of Surgery for Neurologically Compromised Traumatic Cervical Spine Injuries.

Timing of surgical decompression for traumatic cervical spine injuries remains uncertain. Numerous preclinical studies demonstrate the benefit of early decompression, and clinical data are controversial. We review the existing evidence and discuss the effect of timing on clinical, functional, and neurologic outcomes.

Fatal Liver and Lung Alveolar Echinococcosis with Newly Developed Neurologic Symptoms due to the Brain Involvement.

The fox tapeworm Echinococcus multilocularis causes human alveolar echinococcosis, commonly affecting the liver. However, in ∼1% of cases, systematic spread of the disease involves the brain as well. A patient had a 6-year history of liver and lung alveolar echinococcosis that was considered not suitable for surgery, and treatment with albendazole was introduced. After the appearance of neurologic disturbances, an intracranial mass lesion was demonstrated by radiologic imaging. The lesion was surgically removed, and histologic analysis revealed metacestode tissue of E. multilocularis . Despite the surgical resection of the lesion, the patient died of progression of systemic alveolar echinococcosis. The authors highly recommend implementing neurologic monitoring to the follow-up algorithm for patients with systemically disseminated alveolar echinococcosis. When neurologic symptoms occur, radiologic imaging of the brain should be obtained immediately. Surgery should be considered for all intracranial echinococcal lesions, unless the lesion is located in the eloquent brain area.