ABSTRACT
PURPOSE: This report describes a fulminant infection with Clostridium perfringens after an intravitreal anti-vascular endothelial growth factor injection. METHODS: This is a retrospective case review. RESULTS: Our patient's rapid infection eventually led to enucleation, despite broad-spectrum antibiotic therapy. CONCLUSION: Reporting rare causes and common clinical findings of C. perfringens ocular infection may lead to earlier detection and intervention.
Subject(s)
Bevacizumab/adverse effects , Clostridium perfringens/isolation & purification , Eye Infections, Bacterial/microbiology , Panophthalmitis/microbiology , Aged , Angiogenesis Inhibitors/administration & dosage , Angiogenesis Inhibitors/adverse effects , Bevacizumab/administration & dosage , Choroidal Neovascularization/drug therapy , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/etiology , Female , Humans , Intravitreal Injections/adverse effects , Magnetic Resonance Imaging , Panophthalmitis/diagnosis , Panophthalmitis/etiology , Receptors, Vascular Endothelial Growth Factor/antagonists & inhibitors , UltrasonographyABSTRACT
BACKGROUND: Gross total resection (GTR) of cranial base chordomas represents a surgical challenge because of the location, invasiveness, and tumor extension. In the past decade, the endoscopic endonasal approach (EEA) has been used with notable outcomes. OBJECTIVE: To present the endoscopic endonasal experience in the treatment of cranial base chordomas at our institution. METHODS: From April 2003 to March 2011, 60 patients underwent an EEA for primary (n = 35) or previously treated (n = 25) cranial base chordomas. We evaluated the degree of GTR and complications. We studied the factors that influenced outcomes and compared our surgical results in the early and late years of our experience. RESULTS: The overall rate of GTR of cranial base chordomas was 66.7% (82.9% in primary and 44% in previously treated patients). The most important limitations for GTR were tumor volume greater than 20 cm (P = .042), tumor location in the lower clivus with lateral extension (P = .022), and previously treated disease (P = .002). The learning curve had a significant impact on GTR, increasing the success rate to 88.9% (92.6% in primary patients and 63.6% in previously treated patients) during recent years (P < .0001). The most frequent complication was cerebrospinal fluid leak (20%) resulting in meningitis in 3.3%. Carotid injuries occurred in 2 patients without any resulting deficit. Neurological complications included new cranial neuropathies (6.7%) and long tract deficits (1.7%). There was no operative mortality in our series. CONCLUSION: For the treatment of cranial base chordomas, the EEA is a competitive alternative to transcranial approaches with minimal morbidity and high success rates of GTR when performed by experienced cranial base surgeons.
Subject(s)
Chordoma/surgery , Learning Curve , Neuroendoscopy/methods , Skull Base Neoplasms/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Neuroendoscopy/adverse effects , Postoperative Complications/etiology , Retrospective Studies , Skull Base/surgery , Treatment Outcome , Young AdultSubject(s)
Dissection/methods , Endoscopy/methods , Oculomotor Muscles/surgery , Ophthalmologic Surgical Procedures/methods , Orbital Neoplasms/surgery , Diplopia/prevention & control , Humans , Magnetic Resonance Imaging , Nose , Optic Nerve Injuries/prevention & control , Orbital Neoplasms/diagnosis , Treatment OutcomeABSTRACT
INTRODUCTION: Neurotrophic keratitis, a degenerative corneal disease caused by trigeminal nerve impairment, has many etiologies and remains very difficult to treat. METHODS: Case report of a 23-year-old male with a right corneal ulcer that failed to improve despite broad-spectrum antimicrobials. RESULTS: Prior diagnosis of disseminated lymphangiomatosis with a lesion in the right petrous apex effacing Meckel's (trigeminal) cave in conjunction with a history of nonhealing corneal abrasions suggested a neurotrophic etiology. Drawstring temporary tarsorrhaphy, in addition to antibiotics and autologous serum, lead to successful clearing of the infection and resolution of the corneal ulcer. Visual acuity improved from light perception (LP) at the peak of infection to 20/40 six weeks after treatment. CONCLUSIONS: To our knowledge, we report the first case of neurotrophic keratitis in a patient with disseminated lymphangiomatosis that caused a mass effect in Meckel's (trigeminal) cave leading to compression of the trigeminal nerve. The antibiotic-resistant corneal ulcer was successfully treated with drawstring tarsorrhaphy, confirming the utility of this therapeutic measure in treating neurotrophic keratitis.
