The successful surgical management of a rare case of infratentorial tubercular abscess in an immunocompetent pediatric patient.

Tuberculosis (TB) is a chronic infectious disease commonly diagnosed in developing countries. Even though it is a disease primarily affecting the lungs, it can occur in most of the organs of the body. When it affects the central nervous system (CNS), it can result in various neurological sequelae and even death due to increased intracranial pressure. While supratentorial tubercular lesions are relatively common, the disease affecting the infratentorial compartment is very rare, that too in an immunocompetent pediatric patient. Here we report the case of a 5-year-old boy who presented with features of raised intracranial pressure and was diagnosed to have a cerebellar lesion causing hydrocephalus. An emergency surgical decompression was performed and the histopathological examination revealed that the lesion was suggestive of tubercular abscess. The postoperative scan revealed adequate decompression of the lesion with no adverse events and resolution of hydrocephalus. The child recovered without any neurological deficits and anti-tuberculous treatment was continued for one year, but was subsequently lost to follow-up. The successful surgical treatment of a tubercular abscess at a rare location is described.

Rationale Behind the Use of Double-Layer Polypropylene Patch (G-patch) Dural Substitute During Decompressive Craniectomy as an Adhesion Preventive Material for Subsequent Cranioplasty with Special Reference to Flap Elevation Time.

OBJECTIVE: Dural substitutes are used in decompressive craniectomy (DC) to prevent adhesions during subsequent cranioplasty. Current literature attributes them to reduced blood loss and reduction in operative time of cranioplasty. The use of double-layer substitute has rarely been documented. We studied the use of double-layer G-patch as a dural substitute in DC and evaluated its outcome during subsequent cranioplasty with special focus on flap elevation time and blood loss during cranioplasty. METHODS: We performed emergency frontotemporoparietal decompressive craniectomy using a double layer of G-patch as dural substitute. Subsequent cranioplasty was done in these 35 patients. The development of adhesion formation between the tissue layers, amount of blood loss, and flap elevation time were recorded. RESULTS: During the cranioplasty, a clear and smooth plane of dissection was found between the 2 layers of G-patch in all cases. Average flap elevation time was 21.8 minutes, and average time taken for cranioplasty was 124.12 minutes. Average blood loss was 83 mL. None of the patients required re-exploration for infection of bone flap or postoperative bleed. CONCLUSIONS: While evaluating the use of dural substitute during DC as an adhesion preventive material for subsequent cranioplasty, flap elevation time and blood loss should be taken into account rather than operative time. Double-layer G-patch during DC facilitates subsequent cranioplasty by preventing adhesions between the layers, resulting in easier dissection and reduced blood loss.