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David J. Bonda, Sunil Manjila, Prachi Mehndiratta, Fahd Khan, Benjamin R. Miller, Kaine Onwuzulike, Gianfranco Puoti, Mark L. Cohen, Lawrence B. Schonberger and Ignazio Cali

conventional methods of decontamination. 88 The presence of prion-contaminated instruments in the operating room can pose a serious risk to health care providers and patients. 3 , 11 In the absence of strong evidence against a prion disease diagnosis in a neurosurgical patient, cautionary measures should be taken to prevent iatrogenic transmission of prions via the surgical instruments, as neural tissue presents the highest infectious burden of the disease. 8 TABLE 1. Clinical and histopathological features of the human prion diseases Etiology

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Eric W. Nottmeier, Robert E. Wharen and Naresh P. Patel

I ntradural spinal arachnoid cysts are relatively uncommon spinal lesions. Nonacquired spinal arachnoid cysts can be congenital or idiopathic. 7 , 11 Causes of acquired spinal arachnoid cysts include trauma, infection, inflammation, and hemorrhage. 1 , 4 , 6 , 9 Iatrogenic causes of acquired spinal arachnoid cysts are rare, but have been reported following spinal injections, lumbar puncture, and even skull base surgery. 2 , 3 , 5 , 8 We report 2 cases of iatrogenic spinal arachnoid cyst formation that occurred after incidental durotomy during lumbar

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Julius Griauzde, Vijay M. Ravindra, Neeraj Chaudhary, Joseph J. Gemmete, Marcus D. Mazur, Christopher D. Roark, William T. Couldwell, Min S. Park, Philipp Taussky and Aditya S. Pandey

I ntracranial vessel injury is a dire complication of neurosurgical procedures that presents a significant challenge to the treating physician. The vessel injury commonly manifests as frank vessel disruption leading to a traumatic aneurysm and extravasation of blood or a partial vascular wall injury leading to pseudoaneurysm formation. 4 Various endovascular techniques have been used in the treatment of iatrogenic intracranial vessel injuries, including coil embolization, stent-assisted coil embolization, covered stent placement, and the use of liquid embolic

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Dimitris G. Placantonakis, Eric Lis and Mark M. Souweidane

in which there were intradiploic CSF collections in the calvaria. 1–10 , 12–14 In seven (47%) of these 15 cases no clear history of trauma could be obtained; 2 , 3 , 5 , 13 , 14 in the remaining cases the formation of the fistula was attributed either to trauma (seven cases [47%]) 1 , 4 , 6 , 7 , 9 , 10 , 12 or to iatrogenic origin (one case [7%]). 8 In the last case a right frontal meningoencephalocele in a child who had undergone reconstructive craniectomies for bicoronal synostosis was complicated by an accidental tear of the dura. Of the 15 CSF fistulas

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Gregory C. Wiggins, Stephen L. Ondra and Christopher I. Shaffrey

Iatrogenic loss of lordosis is now frequently recognized as a complication following placement of thoracolumbar instrumentation, especially with distraction instrumentation. Flat-back syndrome is characterized by forward inclination of the trunk, inability to stand upright, and back pain. Evaluation of the deformity should include a full-length lateral radiograph obtained with the patient's knees and hips fully extended. The most common cause of the deformity includes the use of distraction instrumentation in the lumbar spine and pseudarthrosis.

Surgical treatment described in the literature includes opening (Smith-Petersen) osteotomy, polysegmental osteotomy, and closing wedge osteotomy. The authors will review the literature, cause, clinical presentation, prevention, and surgical management of flat-back syndrome.

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Iatrogenic spondylodiscitis

Case report and review of literature

Erol Taºdemirođlu, Ahmet Sengöz and Erdem Bagatur

Iatrogenic intervertebral disc space infection is encountered following microsurgical discectomy, percutaneous laser disc decompression, automated percutaneous lumbar nucleotomy operations, and discography. The purpose of this paper is to present a case report and review the literature on the uncommon origins of pyogenic spondylodiscitis and to emphasize the significance of prophylactic antibiotic therapy following transrectal ultrasonography-guided needle biopsy of the prostate (TUGNBP). According to the authors, this is the first reported case of pyogenic spondylodiscitis as a complication of TUGNBP in the English language literature.

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Neurosurgical Forum: Letters to the Editor To The Editor Lloyd Maliner , M.D. Neurology and Neurosurgery Associates Winter Haven, Florida 1069 1069 The article by Todd P. Thompson, et al. (Thompson TP, Levy E, Kanal E, et al: Iatrogenic pneumocephalus secondary to intravenous catheterization. J Neurosurg 91: 878–880, November, 1999) reminded me of an incident during my medical training. We, in the neurosurgery service, were consulted regarding an elderly patient found to have pneumocephalus of the brain on computerized tomography (CT) scanning. She had been

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Todd P. Thompson, Elad Levy, Emanuel Kanal and L. Dade Lunsford

T he presence of pneumocephalus (“air in the head”) in a patient without a history of undergoing intracranial or intrathecal procedures is a significant radiographic finding that portends a violation of the dural barrier or the presence of infection. When unexplained pneumocephalus is visualized on computerized tomography (CT) scanning, a thorough search for its cause must be pursued. We describe a case of iatrogenic intravascular pneumocephalus that confounded the evaluation and treatment of a patient. To determine the incidence of this radiographic finding, we

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Todd A. Patrick, Caterina Giannini, Michael J. Ebersold and Michael J. Link

M etastatic seeding of primary intracranial tumors has been described for numerous CNS histopathological entities of either a benign 3 , 5–7 , 9 , 12 , 15–19 , 23 or malignant 1 , 2 , 9–11 , 13 , 14 , 20–22 nature. Benign tumors associated with this phenomenon include craniopharyngiomas, choroid plexus tumors, central neurocytomas, and pituitary adenomas. These ectopic foci are most frequently thought to be secondary to spontaneous cellular dispersion along CSF pathways; however, iatrogenic causes are frequently suspected as well. Numerous reports have

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Frank Eggers, Robert Lukin, A. Alan Chambers, Thomas A. Tomsick and Raymond Sawaya

I atrogenic carotid-cavernous fistula following Fogarty catheter carotid thromboendarterectomy was first reported by Davie and Richardson. 2 Six similar cases have been reported subsequently 1, 7–9, 15 ( Table 1 ). Case Report This 62-year-old man first sought ophthalmological consultation because of minimal left visual difficulty. TABLE 1 Summary of eight cases of iatrogenic carotid-cavernous fistula after Fogarty catheter thromboendarterectomy Author, Year Treatment Result Davie & Richardson, 1967 none died