Intrathecal Baclofen Pump Migration Into the Peritoneal Cavity: A Case Report

INTRODUCTION: Intrathecal baclofen pumps are valuable treatment options for those with cerebral palsy. Although subfascial baclofen pump placement is generally preferred over a subcutaneous pump placement due to lower infection rates, rare complications can occur with the subfascial approach such as pump migration. CASE PRESENTATION: The authors here describe a case of baclofen pump migration into the peritoneal cavity of a 26-year-old male patient with cerebral palsy, shunted hydrocephalus, and epilepsy. Because the patient's pump could not be palpated on exam and hence refilled, imaging was undertaken, but did not reveal clear evidence of pump migration. Surgery afterward confirmed that the pump had migrated into the peritoneal cavity through a fascial defect. Baclofen pump had to be replaced instead subcutaneously as well as the patient later had to be readmitted for 2 ventriculoperitoneal shunt revisions due to progression of his hydrocephalus. CONCLUSIONS: Intraperitoneal migration of a subfascially placed baclofen pump is a rare, yet serious complication, which has been reported only once in the literature. We advise neurosurgeons to have a low level of threshold in confirming the location of a baclofen pump with imaging and surgical exploration if necessary in order to avoid detrimental outcomes such as bowel perforation

Transsylvian selective amygdalohippocampectomy for treatment of medial temporal lobe epilepsy: Surgical technique and operative nuances to avoid complications

Background: A number of different surgical techniques are effective for treatment of drug-resistant medial temporal lobe epilepsy. Of these, transsylvian selective amygdalohippocampectomy (SA), which was originally developed to maximize temporal lobe preservation, is arguably the most technically demanding to perform. Recent studies have suggested that SA may result in better neuropsychological outcomes with similar postoperative seizure control as standard anterior temporal lobectomy, which involves removal of the lateral temporal neocortex. Methods: In this article, the authors describe technical nuances to improve the safety of SA. Results: Wide sylvian fissure opening and use of neuronavigation allows an adequate exposure of the amygdala and hippocampus through a corticotomy within the inferior insular sulcus. Avoidance of rigid retractors and careful manipulation and mobilization of middle cerebral vessels will minimize ischemic complications. Identification of important landmarks during amygdalohippocampectomy, such as the medial edge of the tentorium and the third nerve within the intact arachnoid membranes covering the brainstem, further avoids operator disorientation. Conclusion: SA is a safe technique for resection of medial temporal lobe epileptogenic foci leading to drug-resistant medial temporal lobe epilepsy

Endoscopic transpterygoid approach for resection of trigeminal neurotropic melanoma: Case report and technical note

Background The endoscopic transpterygoid approach to Meckel's cave is an established technique for resection of trigeminal schwannomas. Modern endoscopes provide excellent intraoperative visualization of anatomic structures and relevant pathology while the minimally-invasive nature of the procedure allows for rapid postoperative recovery. Neurotropic melanoma is a rare clinical entity that often involves the head and neck and can lead to cranial neuropathies when nerve invasion occurs. Pathological diagnosis of this lesion can be challenging due to its rarity and lack of classic melanoma markers such as Melan-A and HMB-45. Case description In this article, the authors describe the endoscopic transpterygoid approach to a neurotropic melanoma involving the maxillary and infraorbital nerves. To our knowledge, this is the first use of this surgical approach for resection of neurotropic melanoma. Conclusions Endoscopic approaches to the trigeminal nerve allow for safe and effective resection of these lesions. However, a strong understanding of the microsurgical anatomy is necessary prior to such an undertaking