✓ In a patient with thrombosis of the central retinal artery, plain skull radiographs showed an enlarged sella turcica and computerized tomography revealed ventricular dilatation. Neuroradiological examination demonstrated stenosis of the Sylvian aqueduct and an unusual type of empty sella due to intrasellar persistence of the recessus infundibuli and the presence of an intrasellar arachnoidocele. The former anomaly has been reported in only three cases; in none of them was it associated with the latter abnormality.
Bernard Vallee, Gérard Besson, Hervé Person and Nagi Mimassi
Phong Dam-Hieu, Jean-François Mineo, Alionka Bostan, Michel Nonent and Gérard Besson
✓ Among spinal arteriovenous malformations (AVMs), dural arteriovenous fistulas (DAVFs) should be distinguished from intradural AVMs. The authors report the unusual and well-documented case of a 49-year-old man who suffered from a rapidly progressive myelopathy. Two concurrent spinal AVMs (one DAVF and one intradural direct AVF [Anson—Spetzler Type IV-B AVM]) were found located in the midthoracic region and in the conus medullaris, respectively. Both AVMs were successfully treated by surgery. To the authors' knowledge, the association of these two pathological entities has not been previously described. Clinically, if the patient fails to improve or deteriorates after the treatment of a spinal AVM, the presence of another AVM should be investigated by repeated angiography, especially if a complete spinal angiography study was not initially performed.
Claire Lietard, Véronique Thébaud, Gérard Besson and Benoist Lejeune
The purpose of this study was to determine the incidence rate and risk factors of surgical site infections (SSIs) in neurosurgery for any type of surgery and any American Society of Anesthesiologists class.
The authors undertook an exhaustive 18-month prospective survey including patients who underwent neurosurgery. In particular, a 30-day follow-up was completed in patients whose surgery did not involve placement of a prosthesis or implant, and 1-year follow-up was completed for patients who underwent surgery to place a prosthesis or implant. The Centers for Disease Control definition of SSI was used. Univariate and multivariate analyses were conducted; all dependent variables found in univariate analysis were entered in the multiple regression model. A stepwise multiple logistic regression method was used.
Of the 844 patients studied, 35 SSIs were diagnosed, yielding an incidence rate of 4.1% (95% confidence interval 3.6–4.5). Independent predictive risk factors for infection were cerebrospinal fluid leakage, external shunt, Altemeier class, and further neurosurgery. A lack of antibiotic prophylaxis was not found to be a risk factor.
Infection risk factors occur mainly during the postoperative period.
Bernard Vallée, Gérard Besson, Jean Gaudin, Hervé Person, Jean-Marie Le Fur and Jacques Le Guyader
✓ The authors report the case of a 22-month-old girl who developed cervical pain, neck stiffness, and quadriparesis over 12 days. An epidural hematoma was removed, with complete recovery after 6 months. There was no history of trauma. A search of the literature revealed eight previous cases of spontaneous spinal epidural hematomas in children under the age of 10 years.