Neuroinfección por Vibrio cholerae no O1/ no O139 secundaria a la derivación ventriculoperitoneal. Reporte de caso / Vibrio cholerae no o1/ no 0139 neuroinfection secondary to ventriculoperitoneal shunt: case report

RESUMEN La infección de la derivación ventriculoperitoneal es una de las complicaciones más frecuentes en este procedimiento. Vibrio cholerae O1 y O139 es una bacteria gram negativa conocida principalmente por ser la responsable del cólera epidémico. No obstante, existen serotipos no O1/ no O139 capaces de causar afecciones extraintestinales, entre ellas se han reportado casos de neuroinfección. Presentamos el caso de una paciente con 9 meses de edad que posterior a la colocación de una derivación ventriculoperitoneal como tratamiento de hidrocefalia obstructiva congénita, presentó un cuadro de neuroinfección y el síndrome de malfunción valvular; se pudo aislar la Vibrio cholerae no O1/ no O139 en el líquido cefalorraquídeo y en la punta del catéter. Es el primer reporte en la literatura en la que se aísla la Vibrio cholerae no O1/ no O139 en líquido cefalorraquídeo secundario a infección de una derivación ventriculoperitoneal.

SUMMARY The infection of the ventriculoperitoneal shunt is one of most frequent complications for this procedure. Vibrio cholera O1 and O139 is a Gram negative bacteria known mainly for being responsible of the epidemic cholera, however, there are serotypes no O1/ no O139 capable of causing extraintestinal conditions, among them neuroinfection cases have been reported. We present the case of a 9 months old patient who after the placement of a ventriculoperitoneal shunt as treatment for connate obstructive hydrocephalus, presents a neuroinfection condition and valve malfunction syndrome, being able to isolate the Vibrio cholerae no O1/ no O139 in the cerebrospinal fluid and the tip of the catheter. It is the first report in the literature in which the Vibrio cholerae no O1/ no O139 is isolated in the cerebrospinal liquid secondary to an infection from a ventriculoperitoneal shunt.

Posterior placement of an expandable cage for lumbar vertebral body replacement in oncologic surgery by posterior simple approach: technical note.

STUDY DESIGN: Technical note. OBJECTIVE: To illustrate that posterior placement of expandable cages could be made without any different devices that the ones ordinarily for the procedure. An example case is described. Decompression techniques for vertebral body destruction by tumors and invasion of the spinal canal could need a second surgery for the resection of the tumor and stabilization of the anterior column, which could add morbidity for the patient. The possibility to perform a posterior decompression and anterior reconstruction at the same surgical approach represents an attractive option. SUMMARY OF BACKGROUND DATA: Reconstruction of the anterior column from a posterior approach could be easier for the patient and for the surgeon with this technique. METHODS: A 17-year-old woman with a benign fibrous histiocytoma in L5 with severe bone destruction, anterior and posterior underwent posterior decompression, vertebral body replacement at the same approach with an expandable cage and L4 S1 pedicle screw fixation in a single stage surgery. This technique consist the resection of the tumor was performed under microscopic view and the vertebral body defect in L5 was resized with a high speed drill to allow the placement of the cage. Over the shoulder of the L5 root and with a gentle traction, the expandable cage was placed in situ with the help of 4 silk threads attached to the heads of the cage, passed ventral and lateral to the dural sac, and roots to facilitate its manipulation and rotation similarly to the Hunt-Shen-Arlet technique. (Hunt T, Shen FH, Arlet V. Expandable cage placement via a posterolateral approach in lumbar spine reconstructions. Technical note. J Neurosurg Spine 2006;5:271-4.) Once the expandable cage is in situ, the headpieces of the parallel distractor are placed over the cage, the upper one over the shoulder of the L5 root under gentle traction on the dural sac, and the lower on over the shoulder of the S1 root under gentle traction too. The distractor was used to rotate the cage at its final position and distracted in situ; the current system instruments provided by the manufacturer were used during the procedure. Then apedicular screw fixation was performed between L4 and S1, and fusion was completed with synthetic bone graft substitute (beta-tricalcium phosphate). RESULTS: Using a modification of the Hunt-Shen-Arlet technique, without the use of a special distraction devices, the expandable cage was successfully implanted and expanded in situ. The clinical result was excellent. CONCLUSION: A surgical technique for the replacement of vertebral body by posterior approach is presented. This technique could be used in surgery of vertebral body tumors of the lumbar spine, in a single surgical approach.

Fijación de la columna cervical subaxial con tornillos pediculares: informe de dos casos y revisión de la literatura / Subaxial transpedicular screw fixation on cervical vertebrae

La fijación cervical con tornillos pediculares es una técnica quirúrgica de reciente aparición que fue descrita inicialmente para el manejo de lesiones traumáticas, pero que actualmente se utiliza incluso en tumores de columna y lesiones degenerativas. El autor presenta su experiencia con dos casos de lesión traumática de columna cervical tratados quirúrgicamente con fijación con tornillos pediculares cervicales en la columna subaxial. Se revisa la literatura disponible de estudios antropométricos, técnicas quirúrgicas, ventajas biomecánicas y complicaciones esperables con esta técnica. La fijación cervical con tornillos pediculares para lesiones traumáticas y no traumáticas es una opción quirúrgica demandante, con claras ventajas biomecánicas y riesgos establecidos, que debe ser tenida en cuenta en casos con indicación de doble abordaje anterior y posterior y fijaciones extensas.