RESUMO
Intra-abdominal migration of the catheter and formation of a cerebrospinal fluid pseudocyst are both rare complications of a ventriculoperitoneal shunt. Traditionally, each condition is treated by a formal laparotomy. Laparoscopic management of the complications in two patients is described.
Assuntos
Adulto , Líquido Cefalorraquidiano/metabolismo , Cistos/etiologia , Evolução Fatal , Migração de Corpo Estranho/etiologia , Humanos , Laparoscopia , Masculino , Reoperação , Derivação Ventriculoperitoneal/efeitos adversosRESUMO
A rare case of a diffuse calvarial meningioma in a sixty-three year-old female is reported. The patient presented with headache, painful proptosis and chemosis of the left eye. Imaging showed that the frontoparietal calvarium on both sides and the left orbital roof were thickened. The thickened bone showed patchy rarefaction. In relationship to the thickened bone, there was an enhancing en-plaque meningioma. The tumour extended on to the superolateral aspect of the left orbit and resulted in proptosis. Excision of the left frontoparietal calvarium and the orbital tumour was performed. The management of diffuse calvarial meningioma is discussed and the relevant literature is briefly reviewed.
Assuntos
Diagnóstico Diferencial , Feminino , Humanos , Meningioma/patologia , Pessoa de Meia-Idade , Fotomicrografia , Neoplasias Cranianas/patologia , Tomografia Computadorizada por Raios XRESUMO
Brain abscesses were studied in 47 patients. Thirty-four (72%) of them were between 5-15 years and 9 were infants. Otogenic source (34%) was the commonest predisposing factor, followed by scalp and face infection (21.3%) and congenital cyanotic heart disease (12.8%). Twenty (42%) patients had multiple abscesses. Supratentorial abscesses were commonest (75.9%). Predominant clinical features were fever (87.2%), raised intracranial tension (78.7%) and altered sensorium (53.2%). A total of 38.3% presented with focal neurological deficit and 34% were admitted in Grade III or IV coma. Diagnosis of abscess and monitoring of its evolution was done principally by CT scanning. Causative organisms were isolated in 54.8% of cases and Staphylococci, Proteus and Pseudomonas were the common pathogens. Therapy was most often a combination of surgical aspiration with or without excision in addition to antimicrobial therapy. The overall mortality in our series was 44.7%. Bad prognostic factors were Grade III/IV of coma at admission, age below 2 years and multiple abscesses.
Assuntos
Adolescente , Abscesso Encefálico/diagnóstico , Criança , Pré-Escolar , Terapia Combinada , Feminino , Seguimentos , Humanos , Lactente , Masculino , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
A 16 year old male was admitted with a clinical picture suggesting an intracranial pyogenic infection. He also has focal convulsions and left abducens palsy. CT scan showed a subdural empyema with interhemispheric extension. Since the patient was improving clinically, neurosurgical intervention was deferred. Spontaneous interhemispheric empyema is an uncommon condition. In our case conservative management was curative in what is considered a neurosurgical emergency.