ABSTRACT
The authors present a unique case of multiple spinal meningiomas with the late development of intracranial lesions. The patient had 47 distinctly separate, yet histologically identical, lesions excised, with many others noted at the time of surgery and by radiographic studies. He was evaluated for neurofibromatosis and was found to have neither Type I nor Type II. Genetic analysis, including restriction fragment length polymorphism analysis, was performed and detected no abnormalities.
Subject(s)
Meningeal Neoplasms/surgery , Meningioma/surgery , Neoplasms, Multiple Primary/surgery , Adult , Chromosome Aberrations/genetics , Diagnosis, Differential , Humans , Magnetic Resonance Imaging , Male , Meningeal Neoplasms/genetics , Meningeal Neoplasms/pathology , Meningioma/genetics , Meningioma/pathology , Neoplasms, Multiple Primary/genetics , Neoplasms, Multiple Primary/pathology , Neurofibromatoses/genetics , Neurofibromatoses/pathology , Neurofibromatoses/surgery , Neurologic Examination , Postoperative Complications/pathology , Postoperative Complications/surgery , Reoperation , Spinal Cord/pathologyABSTRACT
A closed external ventricular drainage system that incorporates a Broviac catheter, with its dacron cuff, is described and its use is detailed. This device has been placed in 17 patients who have undergone 19 procedures. Indications for prolonged cerebrospinal fluid (CSF) drainage were: CSF leak (1 child) and shunt infection (16 children). Drainage was maintained for an average of 19 days, with a range of 6-47 days. The child with the CSF leak had resolution of this problem after 15 days, whereupon the system was removed. Thirteen of the 16 patients with shunt infections eventually underwent shunt placement. Two of the children in this group developed a shunt infection unrelated to their original septic episode that required placement of a second Broviac ventriculostomy. Two of the 3 children who did not undergo permanent shunt placement expired from other causes. Both of these children had clinically functioning Broviac ventriculostomies and culture-proven sterile CSF at the time of death. The remaining child with an infected shunt died of overwhelming sepsis. Complications included: ventricular catheter revision (4 cases), irrigation of the system (4 cases), and secondary CSF infection (1 case). The infection attack rate was 1 in 361 patient-catheter days, or 2.77/1,000 patient-catheter days. The advantages of the Broviac ventriculostomy are two. First, this system is highly resistant to infection. Second, the device is difficult to dislodge.