Management of postoperative infections after spinal instrumentation

The authors retrospectively reviewed 452 consecutively treated patients who underwent a spinal instrumentation procedure at a single institution to establish which patients and which surgical approaches might be associated with an increased risk of developing deep wound infections and to determine the efficacy with which the institution's current treatment strategy eradicates these infections. Wound infections occurred in 17 patients (10 men and seven women) with spinal instrumentation (incidence 3.8%). All infections occurred after posterior spinal instrumentation procedures (7.2%); there were no infections after anterior instrumentation procedures regardless of the level. Each patient was assigned an infection risk factor (RF) score depending on the number of RFs identified in an individual patient preoperatively. The mean RF score of patients who developed infections was 2.18, whereas the mean RF score for a procedure-matched, infection-free control group was 0.71. The mean number of days from surgery to clinical presentation was 27.6 days (range 4-120 days), and the mean increase in hospitalization time for the subset of patients who developed infections was 16.6 days. The most common organism isolated from wound cultures was Staphylococcus aureus (nine of 17 cases). Of the 17 patients, five had infections involving multiple organisms. All patients were infection free at a minimum of 8 months follow-up review. The current treatment regimen advocated at this institution consists of operative debridement of the infected wound, a course of intravenous followed by oral antibiotic medications, insertion of an antibiotic-containing irrigation-suction system for a mean of 5 days, and maintenance of the instrumentation system within the infected wound

Pediatric craniovertebral junction trauma

The craniovertebral junction consists of the occiput, atlas, and axis, along with their strong ligamentous attachments. Because of its unique anatomical considerations, trauma to the craniovertebral junction requires specialized care. Children with potential injuries to the craniovertebral junction and cervical spinal cord demand specific considerations compared to adult patients. Prehospital immobilization techniques, diagnostic studies, and spinal injury patterns among young children can be different from those in adults. This review highlights the unique aspects in diagnosis and management of children with real or potential craniovertebral junction injuries

Combined Occipital-suboccipital Craniotomy

The most frequent location for meningiomas of the posterior fossa, in our experience, is on the posterior surface of the petrous bone (Fig. 28-1). The major blood supply to these very vascular tumors arises from short branches of the internal carotid artery as the blood passes through the carotid canal within the petrous bone. Additional vessels from the posterior branches of the middle meningeal artery and from meningeal branches of the vertebral artery feed the tumor. In medially placed tumors near the clivus, the blood supply may be identical to that for a clivus meningioma. These tumors are attached to the dura over the posterior surface of the petrous bone anterior and superior to the internal auditory meatus and to the undersurface of the tentorium. The tentorium may be perforated by the tumor just as the falx is often penetrated by meningiomas in that location

Cortical Blood Flow During Extracranial-Intracranial Bypass Surgery

Cortical Mood flow was evaluated at the time of surgery with a thermal diffusion flow probe in 25 extracranial -intracranial bypass operations. The procedures were performed 14 times for carotid occlusion, 6times for inaccessible carotid stenosis, on 3 occasions for middle cerebral occlusion, once for basilar occlusion and once for middle cerebral stenosis. Fifty-seven different cortical regions were evaluated before and after completion of the anastomosis. During temporary occlusion of the cortical vessel, no significant changes in cortical blood flow were identified. The mean flow pre-bypass was 58 ml/100 g/min and post bypass was 66. This was a significant difference. When Initial ischemic areas were evaluated, flows increased from 36 ml/100 g/min to 52 ml/100 g/min. These postbypass flows were statistically different than the flow values in the nonischemic areas of 75 ml/100 g/min. Blood pressure and arterial carbon dioxide tension did not vary significantly. Extracranial-intracranial bypass increases cortical flow in ischemic areas although this does not bring the flow into the normal range. © 1984 American Heart Association, Inc

Cauda Equina: Conus Medullaris Ependymoma

Tumors of the cauda equina-conus medullaris region are often well-defined, small masses attached to the filum terminale. These lesions are dissected from the nerve roots and the tip of the spinal cord relatively easily. A portion of uninvolved filum terminale is usually present between the tumor and spinal cord. The afferent and efferent segments of the filum must be amputated to remove the tumor. Small and moderate-sized tumors do not require internal decompression. Recurrences after successful en bloc resections are rare