Bacterial ventriculitis is one of the most common and serious complications of shunt placement. Shunt infection has varied management and is difficult to treat neurosurgically. We report a case of intraventricular empyema due to shunt infection. Standard management was failed for this case and reaccumulation of pus in the both ventricles. Neuroendoscopic surgery with intraventricular lavage and aspiration using cannula nasogastric tube (NGT) through a single burr hole, has successfully decreased the accumulation of intraventricular empyema. After lavage and aspiration, antibiotic can be distributed effectively to the affected area. Follow up imaging and cerebrospinal fluid (CSF) culture shown a good result and shorter length of stay in the hospital. Neuroendoscopy appears effective and safe for the management of bacterial ventriculitis due to shunt infection in infant. The strategy described in this report might be useful to treat intraventricular empyema.

Background: Primary central nervous system lymphoma (PCNSL) is a rare cancer accounting for less than 3% of primary brain and central nervous system (CNS) tumors. Tissues involved include the brain parenchyma, leptomeninges, eyes, and spinal cord. High-dose methotrexate (HD-MTX) is the gold standard for newly diagnosed PCNSL. However, the efficacy of stereotactic radiosurgery (SRS) instead of whole brain radiotherapy following HD-MTX for PCNSL is unclear. The purpose of this study is to determine the effectiveness of HD-MTX in combination with SRS in the treatment of PCNSL. Methods: This is a retrospective, observational cohort study evaluating the treatment of histologically confirmed PCNSL with HD-MTX as a single agent in a dose of 3.5 g/ m 2 (control) and treatment with MTX plus SRS. Strict inclusion and exclusion criteria were employed. Primary outcomes were measured by overall survival. Secondary outcomes were assessed by the tumor's responsiveness to treatment and reduction in size as noted on imaging, the Karnofsky Performance Status (KPS), the activities of daily living (ADL) and mini-mental state examination (MMSE). Results: Between January 2008 and January 2013, 68 cases were evaluated. Included in this evaluation were 42 chemotherapy and 26 chemotherapy, plus SRS. The follow-up period was 24 to 50 months (mean: 32.8 months). There were no statistically significant differences in patient demographics or histology diagnosis. Patients were treated with SRS doses ranging from 11 Gy to 16 Gy (mean: 13 Gy). The median survival rate from initial diagnosis was 28.6 months in the chemotherapy group and 48.6 in the chemotherapy, plus SRS, group (p-value: 0.0051). No significant side effects related to SRS were observed. During follow-up period, the good ADL preservation was achieved for 16 months from SRS. Patients with KPS >90 at SRS demonstrated longer ADL preservation (36 months from SRS). No significant difference in MMSE between two groups were found. Conclusions: SRS in combination with high-dose methotrexate provided better prognosis and not worse neurocognition state. This noninvasive treatment modality should be considered as an option for patients with PCNSL, but should be validated in a large patient population. Legal entity responsible for the study:

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Fractures of the odontoid process can lead to gross instability of the atlantoaxial complex and present a significant risk for a potentially catastrophic spinal cord injury. Type II odontoid fractures are the most common odontoid fractures and are unstable that may displace anteriorly or posteriorly.  If left untreated, the patient may develop atlantoaxial dislocation that causes neurological deficit also progressive myelopathy.We described the surgical management of four patients with a delayed neurological deficit after odontoid fracture with a history of trauma and after triggered by traditional massage. Traction several days before operation applied to achieve reduction of atlantoaxial dislocation.Posterior instrumentation and correction of atlantoaxial dislocation were performed with interarticular screw fixation (Harm technique) in all of the patients.All of the four patients showed a reduction of the atlantoaxial dislocation and also a neurological improvement. Cervical traction followed by posterior instrumented correction may be an effective alternative to treating delayed neurological deficits after traumatic odontoid fracture.