Cladophialophora bantiana: a rare cause of fungal brain abscess. Clinical aspects and new therapeutic options

Black molds or dematiaceous fungi are rare etiologic agents of intracerebral abscesses and such infections carry a high mortality of up to 70% despite combined surgical and antifungal therapy. While the growing use of immunosuppressive therapies and organ transplantation have caused an increase in the incidence of rare fungal cerebral infections, occurrence in immunocompetent hosts is also possible. We describe a 60-year-old female patient with a cerebral abscess caused by Cladophialophora bantiana. The case illustrates the clinical and radiological similarities between glioblastomas and brain abscesses and emphasizes the need to perform histological and microbiological studies prior to the initiation of any form of therapy. Long-term survival from cerebral black mold abscesses has been reported only when complete surgical resection was possible. The recommended antifungal treatment involves the use of amphotericin B combined with a triazole and, if possible, flucytosine. Highly-active new generation triazole antifungal compounds (voriconazole or posaconazole) are likely to offer improved survival rates for patients with rare mold infections. In particular, posaconazole could be a new therapeutic option given its better tolerance, lower toxicity and fewer drug-drug interactions. We discuss clinical, microbiological and practical pharmacological aspects and review current and evolving treatment option

Clipping of MCA aneurysms: how I do it

Introduction: Aneurysms located at the middle cerebral artery bifurcation remain a clear neurosurgical indication. We detail here the steps necessary to enable safe surgery for Sylvian fissure aneurysms. Methods: An angiogram with 3D reconstruction is obtained and reviewed intraoperatively, just prior to the skin incision. During the exposure, the cistern is kept open by small cottonoids, thereby avoiding brain retraction. Continuous monitoring of MEPs along with ICG microscopic angio-fluorescence allows for detection of vascular compromise. Intraoperative angiography with 3D reconstruction allows for immediate correction of less than satisfactory surgical outcome. Conclusions: Careful planning of surgical strategy followed by a minimally invasive technique (with continuous neuro-monitoring) ensures safe surgery. The availability of intra-operative radiological guidance allows for optimal managemen

Haute pathogénicité pour la souris par voie digestive d’un composant viral du vaccin anti-rabique à virus vivant modifié ERA/BHK. Sur la prophylaxie médicale de la rage en France

Oral transmission of rabies virus has been observed by many authors and it seems that strain differences occur independant of their viral quantity. An experimental vaccine strain ERA/BHK (WIRAB) used in foxes by other authors was found to give satisfactory results as far as antibody response and protection is concerned. In this presentation, the isolation of a plaque from this ERA/BHK vaccine by using another cell system (Vero) and which plaque was subsequently multiplied in Vero cells, showed an extremely high pathogenicity in mice by oral route. The original strain (ERA/BHK) killed also by oral route, but to a lesser degree. In the application of these viruses, all precautions were taken not to provoke lesions during their administration. The importance of this finding warrants immediate prohi bition of the use of this strain ERA/BHK for oral or aerosol vaccination of foxes in control programmes. Its use should not be accepted, because the problem of rabies will be increased and more complicated than diminished, by applying this dangerous method. The authors give full consideration and warnings in respect of the inadequate legislation concerning rabies vaccines in France and other countries which will consider the use of such a vaccine or similar ones. In relation to this important finding of high oral pathogenicity, also public health aspects concerning the original vaccine strain ERA in primary pig kidney cells are mentioned. Government authorities who have licensed the vaccine ERA are invited to reconsider their autorization in relation to this finding of high oral pathogenicity, including France, particu larly in respect of the importation of vaccinated (by ERA-strain) domestic animals, frozen carcasses and their products for human consumption and other purposes. This equally applies to all other living rabies vaccines not yet examined for possible oral pathogenicity

Inhibition of T-type calcium channels protects neurons from delayed ischemia-induced damage.Mol

Abstract: 174 words Introduction: 536 word

La prueba de microfocos fluorescentes: una nueva técnica in vitro para titulación y seroneutralización de virus rábico

Se desarrolló una nueva técnica para titular capas de virus adaptadas a cultivos   celulares y se modificó esta técnica para efectuar pruebas de reducción de microfos fluorescentes con el fin de titular niveles de anticuerpos en sueros de animales vacunados. Ambas pruebas son sencillas de efectuar y evaluar. Las técnicas descriptivas tienen una sencibilidad superior a las pruebas convencionales en ratones y además se pueden afectuar en un corto plazo (30 horas)

Augmented reality in the surgery of cerebral arteriovenous malformations: technique assessment and considerations

Background: Augmented reality technology has been used for intraoperative image guidance through the overlay of virtual images, from preoperative imaging studies, onto the real-world surgical field. Although setups based on augmented reality have been used for various neurosurgical pathologies, very few cases have been reported for the surgery of arteriovenous malformations (AVM). We present our experience with AVM surgery using a system designed for image injection of virtual images into the operating microscope's eyepiece, and discuss why augmented reality may be less appealing in this form of surgery. Methods: N = 5 patients underwent AVM resection assisted by augmented reality. Virtual three-dimensional models of patients' heads, skulls, AVM nidi, and feeder and drainage vessels were selectively segmented and injected into the microscope's eyepiece for intraoperative image guidance, and their usefulness was assessed in each case. Results: Although the setup helped in performing tailored craniotomies, in guiding dissection and in localizing drainage veins, it did not provide the surgeon with useful information concerning feeder arteries, due to the complexity of AVM angioarchitecture. Conclusion: The difficulty in intraoperatively conveying useful information on feeder vessels may make augmented reality a less engaging tool in this form of surgery, and might explain its underrepresentation in the literature. Integrating an AVM's hemodynamic characteristics into the augmented rendering could make it more suited to AVM surgery

Double-lumen balloon microcatheter-assisted occlusion of cerebral vessels with coils: a technical note

The purpose of this study was to describe a balloon-assisted double-lumen microcatheter technique to perform a controlled and tight coil packing of a vascular segment for vessel occlusion. This technique can be performed immediately after a test occlusion with the balloon kept in place and was, as illustrated in six cases, in our experience safe, straight forward to use and fas

The role of shape for aneurysm risk assessment

Although the shape of intracranial aneurysms and the geometry of the surrounding vasculature are commonly taken into account by clinicians when assessing and treating aneurysms, it remains dif- ficult to quantify shape and develop clinical guidelines or tools that accommodate aneurysm shape. Here, we present new evidence that aneurysm shape is a meaningful proxy for disease status, the re- sults of a benchmark analysis comparing novel and established measurement methods for their ability to discriminate between ruptured and unruptured aneurysms, and how these findings can be trans- lated into clinics. We conclude with a plea for multi-centric data collections and present our own contributions to it