Large frontal osseous hemangioma with dural sinus involvement in a patient with Klippel-Trenaunay syndrome: A rare case report.

BACKGROUND: We present one of the first documented cases in the literature of an adult with Klippel-Trenaunay syndrome (KTS) with a large frontal osseous hemangioma. CASE DESCRIPTION: A 30-year-old male presented with a rapidly enlarging frontal skull lesion that had developed in only 3 months. Radiological investigation revealed a highly vascular lesion attached to the frontal bone. The lesion was surgically resected with the patient making complete recovery. Histopathology was consistent with an osseous hemangioma. CONCLUSION: We report the clinical presentation and surgical management of a rare presentation of osseous hemangioma in a patient with KTS.

Remote cerebellar haemorrhage from site of craniotomy: A report of two cases.

Remote cerebellar haemorrhage (RCH) is a rare complication of neurosurgical procedures seldom requiring intervention. We report two cases of RCH. The first unilateral RCH is asymptomatic, the other is bilateral and associated with supratentorial haemorrhage and hydrocephalus requiring intervention. We propose multiple foci of haemorrhage as an adverse prognostic marker in RCH.

Clinically relevant aspects of stem cell technologies: current state of play.

The emergence of stem cell technologies and their potential applications in regenerative medicine have generated immense interest by both the lay public and clinicians. Unproven and unregulated cell-based therapies are commercially available both in Australia and internationally, and reports of patient uptake (stem cell tourism) and associated morbidity are increasingly frequent. Clinicians in all fields will require an enhanced understanding of the basic science principles and current state of play in regenerative medicine in order to effectively counsel patients regarding these therapies in the setting of both commercial ventures and clinical trials. This review aims to concisely highlight the key clinically pertinent features of these trials and briefly discuss the specific therapeutic potential, mechanism of action and risks associated with these variables.

Results of a prospective randomized study comparing a novel retractor with a Caspar retractor in anterior cervical surgery.

BACKGROUND: Retraction injury might explain the soft tissue complications seen after anterior cervical surgery. A novel retractor system (Seex retractor system [SRS]) that uses a principle of bone fixation with rotation has been shown to reduce retraction pressure in a cadaveric model of anterior cervical decompression and fusion. OBJECTIVE: To compare the conventional Cloward-style retractor (CRS) with the SRS in a prospective randomized clinical trial. METHODS: After ethics and study registration (ACTRN 12608000430336), eligible patients were randomized to either the CRS or SRS before 1- or 2-level anterior cervical decompression and fusion. The pressure beneath the medial retractor blade was recorded with a thin pressure transducer strip. Postoperative sore throat, dysphagia, and dysphonia were assessed after 1, 7, and 28 days. RESULTS: Twenty-six patients were randomized. There were no serious complications. Complication rates were low with a trend favoring SRS that was not statistically different. Average retraction pressure with SRS was 1.9 mm Hg and with CRS was 5.6 mm Hg (P < .001 on F test; P = .002 on 2-tailed t test). Mean average peak retraction pressure with the SRS was 3.4 mm Hg and with the CRS was 20 mm Hg (P < .001 on F test; P = .005 on 2-tailed t test). CONCLUSION: The new retractor is safe, and statistically similar complication rates were observed with the 2 systems. The SRS generated significantly less retraction pressure compared with the CRS. This difference can be explained by the different principles governing the function of these retractors. Bone fixation gives stability and rotation reduces tissue pressure, both desirable in a retractor.

Comparison of retraction pressure between novel and conventional retractor systems--a cadaver study.

OBJECT: Sore throat, dysphagia, and dysphonia are very common after anterior cervical surgery; clinical studies show an incidence of up to 60% or more. Neural, mucosal, or muscular injuries during dissection or retraction are regularly discussed, but investigations are few. Retraction pressure causing ischemia might explain these complications. A new anterior cervical retractor system (Seex retractor) using novel principles has been introduced to surgical practice. There are isolated reported investigations comparing different anterior cervical retractors. Therefore, the purpose of this study was to measure retraction pressure on the aerodigestive tract in cadavers during the anterior surgical approach for cervical spine operations performed using either the conventional (Cloward) retractor system or the Seex retractor system. The goal was to find the significance of the shape of the retraction blades (flat vs curved) in retraction pressures. METHODS: In cadavers, the anterior cervical spine was approached surgically at the C3/4, C4/5, C5/6, and C6/7 levels. A simulated anterior discectomy procedure was performed using a Cloward retractor with curved blade, a Seex retractor with curved blade, and a Seex retractor with flat blade at each level. For each retractor application, an online pressure transducer (Tekscan pressure measurement system) is applied between the rear side of the medial retractor blade and medial soft-tissue complex. Retraction pressures are recorded twice for both retractors at each level. Average retraction pressure (ARP), average peak retraction pressure (APRP), pressure distribution along the area of retraction, pressure difference at the edge and surface of the retractor blades, pressure variation with flat and curved blades, and so on were determined and compared. One-way ANOVA and Tukey honestly significant difference tests were used for statistical evaluation. RESULTS: Forty sets of pressure recordings were made in 5 cadavers. The Cloward retractor system showed higher average contact pressure than the Seex retractor system in 36 sets. In 32 sets, the Cloward retractor system showed higher peak retraction pressure than the Seex retractor system. None of the recordings showed uniform pressure distribution over the retracted area. With the Seex retractor itself, the flat blade generated more peak retraction pressure than the curved blades in 28 sets of measurements; it was the reverse in 3 sets; and in 9 sets the peak pressure was almost the same. Higher retraction pressure was noted along the edges of retractor blades in general, and along the convexity of a curved blade. Those parallel bands corresponded to the edges of the retractor blades. The Seex retractor with a curved blade generated the lowest average retraction pressure and average peak retraction pressure (p < 0.01, ANOVA). CONCLUSIONS: Retraction pressure was found not to be uniform all over the retracted surface. Higher retraction pressure was noted along the edges of retractor blades in general, and along the convexity of a curved blade. The conventional retractor system with a curved blade generated significantly higher retraction pressures than the novel Seex retractor with a curved blade.

Reduction in shunt infection using antibiotic impregnated CSF shunt catheters: an Australian prospective study.

Antibiotic impregnated shunt catheters have emerged as a promising tool against the continuing challenge of shunt infection. We present our prospective evaluation of the efficacy of antibiotic (rifampicin and clindamycin) impregnated cerebrospinal fluid (CSF) shunt catheters (AIC) in a mixed paediatric and adult Australian population. We have prospectively evaluated all the cerebrospinal fluid shunt procedures carried out in our institution over a 3-year period since July 2002, after the introduction of AIC in our practice. Patient demographics, indication for shunt procedure, risk factors for infection, shunt infections and other relevant factors were documented. The data has been compared with similar data collected over the previous 7 years of our experience with non-antibiotic impregnated catheters for CSF shunt procedures. Pearson's chi-square and Fisher's exact tests are used for statistical evaluation. From July 2002 to June 2005, 243 shunt procedures were carried out using AICs in 178 patients. There were three shunt infections (1.2%). Rigorous retrospective evaluation of shunt procedures over the preceding 7 years revealed 36 infections in 551 shunt procedures (6.5%). This reduction in the infection rate was statistically significant (p=0.0015 on Pearson's chi-square test and p=0.000529 on Fisher's exact test). We also report that the introduction of ceftriaxone prophylaxis during this period was associated with a reduction in Gram-negative shunt infection, but no effect on overall infection rate. We report rifampicin and clindamycin impregnated CSF shunt catheters significantly reduce the rate of shunt infection in Australian clinical practice. This data and the literature support the routine usage of AIC for all CSF shunt procedures.

Duration of in vivo antimicrobial activity of antibiotic-impregnated cerebrospinal fluid catheters.

OBJECTIVE: Shunt infection is a major neurosurgical concern even after 50 years of experience with shunt surgery. Staphylococcus species are responsible for the majority of cerebrospinal fluid shunt infections. In vitro, antibiotic-impregnated cerebrospinal fluid shunt catheters (AIC) have demonstrated protection against multiple staphylococcus species and strains for reasonable periods. We aim to study the longevity of antimicrobial activity of AIC in vivo by using explanted catheters. METHODS: Twenty-five AICs (rifampicin [0.054%] and clindamycin [0.15%]) were explanted from 18 patients for noninfectious reasons, from 11 to 700 days postimplantation. The catheters were set up on standardized Staphylococcus aureus culture plates to detect antimicrobial activity. Unused fresh AIC segments were used as control in each culture plates. RESULTS: Fourteen explanted AICs demonstrated persistent antimicrobial activity against staphylococcal species. Antimicrobial activity was detected for a period of implantation up to 127 days. This is longer than that predicted by in vitro models. CONCLUSION: The persistent antimicrobial activity is likely to translate to ongoing in vivo antimicrobial protection. This period of protection exceeds that during which most shunt infections occur.