A 5-year epidemiological study of nosocomial bloodstream infections in a neurosurgery department.

The characteristics of nosocomial bloodstream infections (BSIs) in a neurosurgical department were studied over a 5-year period. The rate of nosocomial BSI was 3.0%. Gram-negative bacteria were the most commonly isolated pathogens (65.9% of isolates). For all the pathogens isolated, the rate of resistance to commonly used antimicrobial agents was high. Of the 101 patients with nosocomial BSI, 50 (49.5%) died during their stay at the Department of Neurosurgery. At the same time, overall mortality rate among neurosurgical inpatients without nosocomial BSI was 5.4% (ie, 175 of 3,216 patients died).

Epstein-Barr virus associated primary intracranial leiomyoma in organ transplant recipient: case report and review of the literature.

INTRODUCTION: A 45 year old female renal transplant recipient presented with headaches of 3 months duration. Clinical and radiological evaluation revealed an approximately 4x4 cm rounded, enhancing mass at the left temporal pole. At surgery, the mass had dural attachment and clinically, radiographically, and macroscopically resembled a meningioma. Histopathological analysis revealed a leiomyoma. Epstein-Barr virus (EBV) DNA was demonstrated within the tumour cell nuclei by the in situ hybridisation technique. DISCUSSION: This is the first documentation of an EBV-associated primary intracranial leiomyoma in an organ transplant recipient and provides additional evidence of a possible relation between EBV infection and development of smooth-muscle tumours (SMT). CONCLUSION: With increasing numbers of individuals being on long-term immuno-suppression, EBV-associated SMTs may be encountered more frequently in the future.

Osseous variations of the hypoglossal canal area.

BACKGROUND: The hypoglossal canal is a paired bone passage running from the posterior cranial fossa to the nasopharyngeal carotid space. Hyperostotic variations of this structure have been described. MATERIAL/METHODS: One hundred sixteen adult cadaveric dried skull specimens were analyzed. Several canal features, dimensions, and distances relative to constant and reliable landmarks were recorded. RESULTS: One osseous spur in the inner or outer orifice of the canal was present in 18.10% of specimens (42/232). Two or more osseous spurs were evident in 0.86% of specimens (2/232). However, complete osseous bridging, in the outer or inner part of the canal, was evident in 19.83% of specimens (46/232). Osseous bridging extending through the entire course of the canal was visible in 1.72% of the specimens (4/232). The mean lateral length of the canal was 10.22 mm, the mean medial length was 8.93 mm, the mean transverse and vertical diameters of the internal orifice were 7.44 mm and 4.42 mm, respectively, and the mean transverse and vertical diameters of the external orifice were 6.15 mm and 3.91 mm, respectively. The mean inclination of single hypoglossal canals was 42.3 degrees and 32.4 degrees on the right and left side, respectively. CONCLUSIONS: A detailed and accurate evaluation of the hypoglossal canal topographic anatomy with regard to specific, standard osseous landmarks was performed. Additional data with respect to several morphologic features of the hypoglossal canal area also was obtained. Results of this study provide important information that will enable effective and reliable surgical intervention in the area of the hypoglossal canal.

Lumbar spinal epidural angiolipoma.

Spinal angiolipomas are rare benign tumours most commonly found in the thoracic spine. A case of an extradural lumbar angiolipoma in a 47-year-old female is described. She had a recent history of lower back pain accompanied by sciatica. Lumbar MRI revealed a dorsal epidural mass at the L2-L3 level. The patient underwent a bilateral laminectomy, in which the tumour was totally excised. The pathological examination indicated haemangiolipoma. Post-operatively, the patient's neurological signs and symptoms improved remarkably quickly. MRI at 6 and 18 months after surgery revealed no evidence of tumour recurrence.

Intraoperative facet joint injury during anterior cervical discectomy and fusion: an experimental study.

OBJECT: Disorders of the cervical spine can be successfully addressed by surgical intervention when the choice of such intervention takes into account the possible complications in the treated and adjacent structures. The aim of this study was to investigate the potential for intraoperative trauma in cervical zygapophysial joints and to describe possible pathological changes that may occur during cervical spine surgery. METHODS: Fifteen sheep underwent surgical intervention via an anterior cervical approach; discectomy at the C5-6 level was performed. In 10 animals, the discectomy was accompanied by titanium cage fusion. The sheep were killed immediately after completion of the operation. Radiological examination of the isolated cervical spines followed. Furthermore, the cervical spines were submitted to decalcification and incised using a microtome, and tissue sections were then studied using light microscopy. RESULTS: Radiological examination was used to assess vertebral alignment, vertebral body (VB) morphology, implant position, and endplate and facet joint gross morphology. Histological examination of the endplate and VB demonstrated degenerative lesions as well as cellular necrosis. The study of the facet joints at the treated as well as at adjacent segments (both above and below) revealed in some cases edema between the collagen fibers of the joint capsules, congestion, and microhemorrhages. Injuries were evident in animals in which the Caspar device was used. CONCLUSIONS: Histopathologically confirmed lesions occurred in facet joints while anterior cervical spine surgery was being performed in sheep. The findings were indicative of trauma and, in the case of human spine surgery, could possibly account for several postoperative complications and patient complaints.

Lumbar nerve root compression due to extramedullary hemopoiesis in a patient with thalassemia: complete clinical regression with radiation therapy. Case report and review of the literature.

The authors describe the case of a 24-year-old woman who had a history of beta3-thalassemia and presented with severe symptoms of lumbar nerve root compression due to extramedullary hemopoiesis in the intervertebral foramen. Radiation therapy (2000 cGy in six fractions) was delivered to the mass. The patient's neurological symptoms completely resolved following treatment. Follow-up images showed a reduction in lesion size. The results of this unique case supported by a review of the literature suggest that radiation therapy alone is an effective modality in the treatment of patients with compression of neural structures due to extramedullary hemopoietic tissue.