Objective: Development of discitis after lumbar discectomy is one of the most important complications of disc surgery. This retrospective study investigated the influence of potential contributing factors in 9 cases of postoperative discitis occurring in 2901 patients who underwent macrodiscectomy. Methods: The specific factors considered were age, sex, history of diabetes mellitus, level of the herniated disc, number of levels operated, occurrence of dural tear and cerebrospinal fluid fistula during surgery, postoperative superficial wound infection, and antibiotic regime. Concerning the latter, Group 1 (n=471) received triple-drug multi-dose antibiotic prophylaxis, and Group 2 (n=2430) received single-drug singledose antibiotic prophylaxis. Results: The overall incidence of postoperative discitis in the series was 0.31%. Five of the discitis patients were in Group 1 and four were in Group 2, thus the group rates of postoperative discitis were 1.06% and 0.16%, respectively. The frequencies of discitis according to level of disc herniation were 0.91% for L3-L4, 0.36% for L4-L5, and 0.33% for 15- SI. There was no correlation between postoperative discitis and post-surgery superficial wound infection. Conclusion: The study showed that administering a single prophylactic dose of one antibiotic prior to surgery reduces the risk of postoperative lumbar discitis and superficial wound infection. Of the factors investigated, antibiotic regimen was the only one that was significantly associated with postoperative discitis. Key Words: Lumbar disc herniation, discectomy, discitis
4 Acibadem Universitesi Tip Fakultesi, Norosirurji Anabilim Dali, Istanbul 4 Benign intracranial hypertension may occasionally be associated with cranial nerve palsies. Abducens nerve palsies occur in 10 % to 20 % patients with benign intracranial hypertension, other cranial nerve palsies occur much less frequently. We reported a 25-year-old woman benign intrac- ranial hypertension with bilateral seventh nerve palsy. Complete improvement of her cranial nerve palsy was achieved with lumboperitoneal shunting within 14 days.
To The Editor: A 66-year-old 80 kg woman underwent lumbar laminectomy. Her medical history included hypertension, diabetes mellitus, and hypothyroidism. Her preoperative laboratory values were within normal ranges. Anesthesia was induced with propofol 2 mg/kg and remifentanil 1 μg/kg. After induction, the patient received vecuronium bromide 0.15 mg/kg and dexamethasone 0.2 mg/kg. After endotracheal intubation, she was placed in prone position. Anesthesia was maintained with 50% N2O and 1% sevoflurane in O2 and remifentanil 0.25 μg · kg−1 · min−1 infusion. Surgery lasted 270 min. At the end of the surgery, we reversed the muscle relaxant with 30 μg/kg prostigmine and 15 μg/kg atropine. Twenty minutes after turning off the anesthetics, her spontaneous respiration was irregular and she did not respond to verbal comments. Painful stimulus resulted in eye opening accompanied by right sided-flexor response. Her pupils were anisocoric. To exclude the possibility of an intracranial event (e.g., hemorrhage, emboli, or infarction), we performed emergent computerized tomography, which revealed a right frontal, intracranial contrast-enhanced lesion and midline shift (Fig. 1a). Intracranial tumor with peripheral edema was diagnosed with magnetic resonance imaging (Fig. 1b). Twenty-four hours later the patient underwent craniotomy and tumor excision, with complete neurological recovery.Figure 1.: (a) Cranial axial noncontrast computed tomography, showing a large hypointense area in the frontal lobe that may have been caused by hypotensive cerebral infarction, infiltrating neoplasm, inflammation, etc. (b) Cranial axial T1-weighted magnetic resonance image showing contrast-enhanced frontal tumor (arrow A) causing midline shift (arrow B).Several factors likely contributed to the exacerbation of mass effect and neurological sequelae after the laminectomy, including prone position, intraoperative fluid administration, surgical stress, and residual anesthesia. Delayed recovery from general anesthesia accompanied by neurological findings may be the first sign of intracranial tumor. Arzu Gerçek, MD Department of Anesthesiology Deniz Konya, MD Rasim Babayev, MD Serdar Ozgen, MD Department of Neurosurgery Marmara University Institute of Neurological Science Istanbul, Turkey [email protected]
Diastematomyelia, or split cord malformation, a complete or incomplete sagittal division of the neural axis into halves, is seen in association with many other congenital anomalies. Among these anomalies, intradural spinal teratoma is extremely rare. Diastematomyelia is a well-recognized although unusual clinical syndrome in children, but it is rarely reported in the adult. The authors describe a 42-year-old man who presented with pain and distal left-leg weakness as well as neurogenic claudication for 1 month. The patient underwent radiological examinations, and diastematomyelia and an intradural lumbar teratoma were diagnosed. He underwent surgery and was followed for 1 year. This is the fourth case of an adult who simultaneously presented with diastematomyelia and an intradural teratoma.
To evaluate the results of the anterior transcallosal approach to the colloid cysts of the third ventricle.A retrospective analysis of the patients operated on between 1986 and 2003 was carried out. There were 19 patients (10 female, 9 male) with a median age of 43. The main presenting symptom was headache. One of the patients presented with acromegaly due to a pituitary tumor. The size of the cysts ranged from 15 to 43 mm. An anterior transcallosal approach was used in all patients.The cysts were excised totally in all cases. Postoperatively no recent memory loss has been detected in any patient. One patient with hemorrhagic papil stasis experienced temporary visual worsening. In one patient with hydrocephalus a ventriculoperitoneal shunt was needed. One patient with postoperative superior frontal gyrus venous infarction had a seizure. The follow-up period was from 1 month to 13 years (mean 5.2 years). To date, there has been no recurrence so far.The anterior transcallosal approach is a safe method for the treatment of third ventricular colloid cysts.
