toxicity. Craniopharyngioma was diagnosed in 26 patients at our institution between 1999 and 2006. Of these 26 patients, 10 were considered for intracystic bleomycin therapy. Two patients were excluded because of persistent leakage during the permeability test of the Ommaya reservoir. A total of 13 courses of intracystic bleomycin were administered to eight patients (six in patients in whom craniopharyngioma was recently diagnosed, and seven courses for patients with craniopharyngioma relapses). We report on three cases of patients presenting asymptomatic or with mild
Report of three cases
Lucie Lafay-Cousin, Ute Bartels, Charles Raybaud, Abhaya V. Kulkarni, Sharon Guger, Annie Huang and Eric Bouffet
Vanja Varenika, Peter Dickinson, John Bringas, Richard LeCouteur, Robert Higgins, John Park, Massimo Fiandaca, Mitchel Berger, John Sampson and Krystof Bankiewicz
. 10 , 11 , 23 This method has given us the ability to directly monitor the local delivery of therapeutic agents and has improved the efficacy of CED in animals with spontaneously developed brain tumors. Monitoring the progress of infusions in real-time has revealed that the leakage of therapeutic agents out of brain parenchyma is surprisingly common. As we describe in this report, ~ 20% of our infusions resulted in leakage into ventricles and sulci. These leaks occurred in the middle of the infusion sessions, after the placement of cannulas and the initiation of
Amer Dastgir, Nathan J. Ranalli, Theresa L. MacGregor and Philipp R. Aldana
. Operation The patient was taken to the operating room and placed under general anesthesia. The abdominal baclofen pump and catheter were surgically dissected. The pump tubing was found to cross directly over the refill reservoir of the pump and had an active leakage of the drug from a small puncture hole in the pump catheter just proximal to the straight connector ( Fig. 2 ). The pump was removed, and the leaking segment of the catheter along with a few centimeters of proximal and distal tubing were removed and replaced. The pump was then reimplanted with the catheter
Masato Nakano, Norikazu Hirano, Hirokazu Ishihara, Yoshiharu Kawaguchi and Kousou Matsuura
and prevented vertebral collapse and pseudarthrosis in 16 patients with osteoporotic vertebral fractures. 16 Although CPC does not have the risk of nerve injury associated with an exothermic reaction and hypotension due to absorption of the monomer, CPC-assisted PTV for osteoporotic vertebral fractures may cause certain intraoperative complications such as leakage and embolism. We prospectively reviewed VB CPC leakage after CPC-assisted PTV for osteoporotic vertebral fractures and determined whether the leakage caused any changes in its therapeutic benefits
Junichi Mizuno, Praveen V. Mummaneni, Gerald E. Rodts and Daniel L. Barrow
lumboperitoneal shunt procedures and 1.6% in patients who have had ventriculoperitoneal shunt procedures. 2 Recurrent intracranial SDH caused by a CSF leak due to a spontaneous CSF fistula at a remote location in the lumbar spine has not been previously reported. 1 Our patient’s SDH resolved after surgical repair of the L1–2 CSF fistula. Intracranial hypotension–related headache following minor trauma, administration of lumbar epidural anesthetic agents, or lumbar puncture is a well-recognized phenomenon. Nosik 6 reported a case of symptomatic CSF leakage due to a lumbar
Snjezana M. Schütt, Uwe Kehler, Jan Gliemroth, Dirk Petersen and Jürgen Sperner
development. Moreover, such lesions may be associated with additional congenital anomalies of the brain, such as agenesis of the corpus callosum, hydrocephalus, or craniofacial dysmorphism. 10 The use of both CT scanning and MR imaging is necessary to ensure exact anatomical delineation of the herniated mass and associated anomalies and to assess treatment options in relation to the prognosis. 10 Cases involving CSF leakage should be treated immediately by a neurosurgeon because of the associated high risk of meningitis. Here we present the case of a 10-week
Kyung Sik Ryu, Chun Kun Park, Moon Chan Kim and Joon Ki Kang
option become available. Percutaneous PMMA vertebroplasty has provided good pain relief and improved function in patients treated for osteoporotic vertebral compression fractures. 1, 2, 4, 7–15, 17 Results have been mixed, as some patients experience no improvement after vertebroplasty. Those patients with persistent or aggravated pain were investigated to determine possible causes of treatment failure. One possible cause is the epidural leakage of PMMA after vertebroplasty, which may reduce the therapeutic effects by compressing the spinal cord and/or nerve roots
Jonathan A. Friedman, Michael J. Ebersold and Lynn M. Quast
Persistent posttraumatic cerebrospinal fluid (CSF) leakage frequently complicates skull base fractures. Although many CSF leaks will cease without treatment, patients with CSF leaks that persist greater than 24 hours may be at increased risk for meningitis, and many will require surgical intervention. The authors reviewed their 15-year experience with posttraumatic CSF leaks that persisted longer than 24 hours.
The authors reviewed the medical records of 51 patients treated between 1984 and 1998 with CSF leaks that persisted for 24 hours or longer after traumatic head injury. In 27 patients (55%) spontaneous resolution of CSF leakage occurred at an average of 5 days posttrauma. In 23 patients (45%) surgery was required to resolve the leakage. Eight patients (16%) with occult CSF leaks presented with recurrent meningitis at an average of 6.5 years post-trauma. Forty-three (84%) patients with CSF leaks sustained a skull fracture, most commonly involving the frontal sinus, whereas parenchymal brain injury or extraaxial hematoma was demonstrated in only 18 patients (35%). Delayed CSF leaks, with an average onset of 13 days posttrauma, were observed in eight patients (16%).
Among patients with clinically evident CSF leakage, the frequency of meningitis was 10% with antibiotic prophylaxis, and 21% without antibiotic prophylaxis. Thus, prophylactic antibiotic administration halved the risk of meningitis. A variety of surgical approaches was used, and no significant neurological morbidity occurred. Three (13%) of 23 surgically treated patients required additional surgery to treat continued CSF leakage.
A significant proportion of patients with CSF leaks that persist greater than 24 hours will require surgical intervention. Prophylactic antibiotic therapy may be effective in this group of patients. Patients with skull base or frontal sinus fractures should be followed to detect the occurrence of delayed leakage. Surgery-related outcome is excellent.
Payam Mousavi, Sandra Roth, Joel Finkelstein, Gordon Cheung and Cari Whyne
, 8–10 To date, there has been little research conducted to investigate and quantify factors leading to the higher rate of complication seen clinically in the treatment of metastatic compared with osteoporotic disease along with percutaneous vertebroplasty. The objective of this study was to quantify volumetrically cement distribution in patients with osteoporotic and metastatic lesions undergoing percutaneous vertebroplasty and to establish whether differences exist in leakage and percentage of cement volume with regard to their potential clinical significance at
Ismail Kürşad Gökce, Hatice Turgut, Ramazan Ozdemir and Selami Cagatay Onal
W hen a baby with a meningomyelocele is born, the ideal approach is to close the meningomyelocele sac and treat accompanying pathologies, if any, within the first 24 hours. 4 , 7 Early and late complications after meningomyelocele surgery are closely associated with wound dehiscence. Cerebrospinal fluid leakage is a common complication following meningomyelocele surgery during the wound-healing period. 4 Hyponatremia related to CSF leakage has been reported to occur in preterm infants following external ventricular drainage to treat posthemorrhagic