Continuous Antibiotic Administration Using IRRAflow® Catheter for Treatment of Intracranial Abscess.

Intracranial abscesses are rare lesions with an incidence of approximately 4 per 1 million people. The optimal surgical management of these lesions is still unclear. We present the case of a patient who was discovered to have an intracranial abscess after presenting with right-sided weakness. He was treated via a combination of open craniotomy and continuous antibiotic irrigation using an IRRAflow® catheter (IRRAS, Stockholm, Sweden). Use of the IRRAflow® in this fashion has not yet been described in the literature. This novel approach appears to be safe and resulted in continued decrease in the abscess burden following surgical drainage.

Minimally Invasive Robot-Guided Dual Cortical Bone Trajectory for Adjacent Segment Disease.

Here we present a novel application of cortical bone trajectory (CBT) fixation utilizing robotic guidance in a previously instrumented spine with a traditional pedicle screw (PS), obviating the need for a larger posterior incision, reducing the risk of infection, muscular dissection, and likely decreasing hospital length of stay. A 60-year-old woman with prior left L3-L4 extreme lateral interbody fusion and unilateral percutaneous PS placed at L3 to L5 presented with progressive bilateral lower-extremity pain and diminished sensation in the S1 dermatome secondary to adjacent segment disease (ASD). The patient underwent an L5-S1 anterior lumbar interbody fusion for indirect decompression and restoration of segmental lordosis. After the first stage was completed, she was turned prone for posterior percutaneous instrumentation. Given prior instrumentation at L3-L5 on the left side, a robot planning software was used to plan a cortical bone screw on the left L5 pedicle. A left S1 PS was then planned with the screw head aligning with the left L5 cortical bone screw. Instrumentation was then placed percutaneously using the robot bilaterally without issue. Intraoperative fluoroscopic imaging demonstrated accurate placement of PS, and postoperative computed tomography demonstrated the excellent positioning of all PSs. This report is the first documented case of a robotically placed CBT screw placed in the same pedicle as a prior traditional PS for ASD. This method expands the surgical options for ASD to include robotic percutaneous placement of posterior instrumentation at the same level as previous instrumentation.

Minimally Invasive Approach to Subdural Hematoma Treatment Using IRRAflow Catheter and Middle Meningeal Artery Embolization.

Chronic subdural hematoma (cSDH) is a common neurosurgical pathology that usually occurs in the seventh decade of life. Patients can present with mental status changes, focal neurologic deficits, seizures, headaches, or may be asymptomatic. Recurrence is common. In order to address this problem with the treatment of cSDH, many studies exist that compare the effectiveness of various treatment modalities. Two recently developed treatment options of cSDH include middle meningeal artery (MMA) embolization and use of self-irrigating catheter systems. To our knowledge there have been no reported cases of combining the use of these new treatments. What follows is a case report of a 72-year-old patient with recurrent cSDH following MMA embolization who underwent minimally invasive surgical drainage of his hematoma using an IRRAflow catheter (IRRAS, San Diego, CA, USA).