Complications of posterior cranial fossa surgery—an institutional experience of 500 patients

Dubey, Arvind Kumar; Sung, Wen Shan; Shaya, Mark; Patwardhan, Ravish V.; Willis, Brian J.; Smith, Donald R.; Nanda, Anil

doi:10.1016/j.surneu.2009.04.001

Cited by 173 publications

(106 citation statements)

References 41 publications

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“…Dubey et al (2) reported that CSF leaks were most frequently encountered in 13% of posterior cranial fossa surgery patients, followed by meningitis (9.2%) and wound infection (7%), which are consistent with our findings and other reports (5). In a large scale retrospective survey in Chinese population, Zhan et al (15) drew the conclusion that CSF leakage, CSF drainage of any kind, subsequent short term surgery, and surgery duration were major risk factors of postoperative intracranial infection, indicating that surgery-focused management might be the most effective way to minimize the risk for central nervous system infection after cranial surgery.…”

Section: Discussionsupporting

confidence: 93%

The role of sulfadiazine for the treatment of refractory intracranial infection

Zhang

Hu²,

Ding³

et al. 2014

Turkish Neurosurgery

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AIm: Sulfadiazine (SD) is a classic antibiotic for intracranial infection. Due to the medical market policy, SD has not been chosen as an essential drug in all the hospitals in China. However, its therapeutic effect is definite and cannot be substituted. The aim of this study was to evaluate the therapeutic and economic value of SD compared to other popular antibiotics in patients with refractory intracranial infection. mAterIAl and methOds: A retrospective single-center study was performed from January 2011 until December 2012. Thirteen patients diagnosed with refractory intracranial infection were treated with SD. The clinical effects were reviewed. results: Treatment was successful for 12 of the patients (cure rate=92.3%). One patient died of secondary epilepsy, respiratory complications, and multiple organ failure. Only one patient was allergic to SD, and there were no drug-related liver or kidney side effects.COnClusIOn: SD is a safe, effective, and economical antibiotic, and is used by our neurosurgical department. It should be offered as an option for the patients with refractory intracranial infection, especially for patients with lower ability to pay.

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Section: Discussionsupporting

confidence: 93%

The role of sulfadiazine for the treatment of refractory intracranial infection

Zhang

Hu²,

Ding³

et al. 2014

Turkish Neurosurgery

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“…Combined series, which included both pediatric and adult patients, constituted 61 reports (42%). [5][6][7]9,11,12,[25][26][27]34,37,38,40,43,44,46,47,52,53,55,63,66,67,70,73,74,76,83,87,90,91,94,96,100,102,103,106,110,111,114,115,117,121,126,127,129,130,132,135,[138][139][140]…”

Section: General Informationmentioning

confidence: 99%

Pediatric and adult Chiari malformation Type I surgical series 1965–2013: a review of demographics, operative treatment, and outcomes

Arnautovic

Splavski

Boop

et al. 2015

PED

205

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OBJECT Chiari malformation Type I (CM-I) is a hindbrain disorder associated with elongation of the cerebellar tonsils, which descend below the foramen magnum into the spinal canal. It occurs in children and adults. Clinical symptoms mainly develop from alterations in CSF flow at the foramen magnum and the common subsequent development of syringomyelia. METHODS The authors reviewed English-language reports of pediatric, adult, and combined (adult and pediatric) surgical series of patients with CM-I published from 1965 through August 31, 2013, to investigate the following: 1) geographical distribution of reports; 2) demographics of patients; 3) follow-up lengths; 4) study durations; 5) spectrum and frequency of surgical techniques; 6) outcomes for neurological status, syrinx, and headache; 7) frequency and scope of complications; 8) mortality rates; and 9) differences between pediatric and adult populations. Research and inclusion criteria were defined, and all series that contained at least 4 cases and all publications with sufficient data for analysis were included. RESULTS The authors identified 145 operative series of patients with CM-I, primarily from the United States and Europe, and divided patient ages into 1 of 3 categories: adult (> 18 years of age; 27% of the cases), pediatric (≤ 18 years of age; 30%), or unknown (43%). Most series (76%) were published in the previous 21 years. The median number of patients in the series was 31. The mean duration of the studies was 10 years, and the mean follow-up time was 43 months. The peak ages of presentation in the pediatric studies were 8 years, followed by 9 years, and in the adult series, 41 years, followed by 46 years. The incidence of syringomyelia was 65%. Most of the studies (99%) reported the use of posterior fossa/foramen magnum decompression. In 92%, the dura was opened, and in 65% of these cases, the arachnoid was opened and dissected; tonsillar resection was performed in 27% of these patients. Postoperatively, syringomyelia improved or resolved in 78% of the patients. Most series (80%) reported postoperative neurological outcomes as follows: 75% improved, 17% showed no change, and 9% experienced worsening. Postoperative headaches improved or resolved in 81% of the patients, with a statistical difference in favor of the pediatric series. Postoperative complications were reported for 41% of the series, most commonly with CSF leak, pseudomeningocele, aseptic meningitis, wound infection, meningitis, and neurological deficit, with a mean complication rate of 4.5%. Complications were reported for 37% of pediatric, 20% of adult, and 43% of combined series. Mortality was reported for 11% of the series. No difference in mortality rates was seen between the pediatric and adult series. CONCLUSIONS Before undergoing surgical treatment for CM-I, symptomatic patients and their families should be given clear information about the success of treatment and potential complications. Furthermore, surgeons may benefit from comparing published data with their own. In the future, operative CM-I reports should provide all details of each case for the purpose of comparison.

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“…Further, PMC development in posterior fossa surgery is theorized to be multifactorial and may be driven not only by surgical technique; but also patient factors, increasing age, hydrocephalus, large adjacent CSF cisterns, the effects of gravity causing dural strain in the recumbent position and increased subcutaneous dead space after striping attachments from the occipital bone. [1][2][3][4][5]9 Despite the frequency of PMC complication there is no consensus for treatment and little advancement in terms of optimal management and the timing for intervention for PMCs. 2,6 Traditionally, conservative management is trialed and management proceeds to operative intervention in the form of CSF diversion procedures or revision surgery in patients with non-resolution of the PMC.…”

Section: Discussionmentioning

confidence: 99%

“…2,4,10 If there is active CSF leak this should be initially closed by resuturing. 4 Cappabianca et al described a minimally invasive technique of repeated percutaneous injection of fibrin glue into the PMC collection cavity after aspiration of the CSF; this technique was extrapolated and modified to use in conjunction with an autologous EBP for the successful treatment of a suboccipital PMC by Paternoster et al 7,11 Paternoster and colleagues described the first case of posterior fossa PMC treated by a modified EBP. They described aspiration of the CSF subcutaneous collection and local injection of autologous EBP combined with fibrin glue into the residual suboccipital pouch in 2012.…”

Section: Discussionmentioning

confidence: 99%

“…Further, symptomatic PMCs are associated with worse outcomes in terms of pain, disability and quality of life. 4 Posterior fossa surgery has a higher incidence of PMC complication compared to supratentorial surgery. 5 The development of a clinically relevant or symptomatic posterior fossa PMC is reported to range from 4-23% of cases in the literature.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Epidural blood patch for treatment of a large suboccipital pseudomeningocele

Richardson

Tommasi

2017

Int Surg J

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Pseudomeningocele complication is a challenging and common neurosurgical problem. Posterior cranial fossa surgery is reported to have higher pseudomeningocele postoperative complication rates compared to supratentorial surgery. Treatment of posterior fossa pseudomeningoceles can be cumbersome and various techniques have been described ranging from conservative measures to re-operation. We describe a case of a 27 year old woman who developed a large symptomatic suboccipital pseudomeningocele following posterior fossa decompression surgery; this was successfully treated by an epidural blood patch. The current body of literature regarding the treatment of posterior fossa pseudomeningocele is limited. Whilst the use of an epidural blood patch for pseudomeningocele treatment is not novel, this is the first case of standard epidural blood patch, performed in the lumbar region, for treatment of a posterior fossa pseudomeningocele. Epidural blood patch is a minimally invasive technique that is underutilized. This paper demonstrates the use of epidural blood patch as an alternative method for treatment of a large suboccipital pseudomeningocele and summarizes the current literature. It is hoped this paper will highlight the epidural blood patch as a potentially effective treatment option that should be considered when managing posterior fossa pseudomeningocele complications prior to escalation to surgical revision.

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Complications of posterior cranial fossa surgery—an institutional experience of 500 patients

Cited by 173 publications

References 41 publications

The role of sulfadiazine for the treatment of refractory intracranial infection

The role of sulfadiazine for the treatment of refractory intracranial infection

Pediatric and adult Chiari malformation Type I surgical series 1965–2013: a review of demographics, operative treatment, and outcomes

Epidural blood patch for treatment of a large suboccipital pseudomeningocele

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