Subject(s)
Meningeal Neoplasms/surgery , Meningioma/surgery , Neurosurgical Procedures/methods , Skull Base Neoplasms/surgery , Skull Base/surgery , Adult , Aged , Cohort Studies , Endoscopy , Female , Hearing Loss/surgery , Humans , Magnetic Resonance Imaging , Male , Mastoid , Middle Aged , Neuroma, Acoustic/surgery , Retrospective Studies , Skull Base/anatomy & histology , Temporal Bone , Young AdultABSTRACT
BACKGROUND: Shearing of an intrathecal catheter during implantation of a drug delivery system is an underreported complication that can be challenging to manage. CASE DESCRIPTION: A 53-year-old man with refractory cancer pain had an intrathecal pump system implanted. The procedure was complicated with catheter shear and retention in the intrathecal space. A second catheter was successfully placed but formation of a painful pseudomeningocele and ineffective pain relief complicated the outcome. A minimally invasive approach through a tubular retractor was employed to access the spinal canal via a laminotomy, the sheared catheter was removed and the dural defect repaired. Complete resolution of the pseudomeningocele and efficient pain control were observed at follow-up. CONCLUSION: Minimally invasive approach to the spine is demonstrated as a safe and effective alternative in this case of retained catheter induced cerebrospinal fluid (CSF) leak.
ABSTRACT
Cerebral salt wasting syndrome (CSWS) is a well-described consequence of several neurological disorders. Although the exact etiology of CSWS is still not completely elucidated, it is believed that the hypothalamus plays a pivotal role in the genesis of this disorder. We report for the first time 3 cases of CSWS occurring during the post-operative course following surgical resection of exophytic bulbar pilocytic astrocytomas in children. Since these 3 cases shared in common a medial implication of the medulla, we suggest that specific interconnectivity between the dorso-medial portion of the medulla oblongata and the hypothalamus might thus represent an anatomical pathway of interest in the pathogenesis of CSWS. Our findings suggest that the resection of medially located exophytic bulbar tumors might constitutes a risk factor in the development of CSWS. Particular care should thus be carried towards the prompt detection and treatment of CSWS in the post-operative courses of exophytic bulbar tumors.
