Improving Compliance with Preoperative Nasal Povidone-Iodine to Prevent Surgical Site Infection in Vascular and Neurosurgery Services in a Community Teaching Hospital.

Surgical site infections (SSI) remain a cause of morbidity, prolonged hospitalization, surgical readmission, and death. Nasal colonization with methicillin-resistant Staphylococcal aureus is a frequent cause of device-related SSI and nasal mupirocin has been used for prevention. More recently, povidone-iodine nasal swabs have become an alternative. It is cheaper, ensures compliance and there are no concerns regarding antimicrobial resistance. However, its adoption was suboptimal in a community hospital system in southwestern Ohio, especially in neurosurgery and vascular surgery. Quality improvement techniques, including solicitation of stakeholder input, surgeons and perioperative nurses' education, and the use of reminders to order and administer the povidone-iodine nasal swabs improved physician ordering and nurse administration compliance, leading to fewer infections. The interventions continued after the project was completed, sustaining decreases in neurosurgery and vascular surgery, and fewer SSI through the first years of the pandemic. Despite the complexity of these surgeries, simple interventions were effective in addressing the problem.

In Situ Left Azygous Anterior Cerebral Artery to Right Pericallosal Artery Bypass for Treatment of a Giant Right A1/2 Aneurysm: 2-Dimensional Operative Video.

Here we present a 46-yr-old man with recurrent syncopal episodes thought to be of cardiac origin. He was eventually found to harbor a giant, partially thrombosed, saccular aneurysm arising from the A1/A2 segment of the right anterior cerebral artery with foramen of Monro obstruction and a trapped left-sided ventricular system. An azygous left A2 artery segment supplied both callosomarginal arteries. We performed an in situ side-to-side anastomosis between the distal left azygous anterior cerebral artery and the right pericallosal artery, which was previously supplied by the right A1. The right A1 was clip ligated, and the aneurysm evacuated with an ultrasonic aspirator. Postoperatively, the patient did well with no recurrence of the aneurysm and resolution of his preoperative obstructive hydrocephalus. He continues to be independent >7 yr post surgery. His 6-mo follow-up angiogram revealed a patent bypass.

Spontaneous intratumoral infarction--an unusual evolution of a falcine meningioma.

OBJECTIVE: We report the incidence of spontaneous infarction of a falcine meningioma without preceding hemorrhage and shed light on the relation between intratumoral necrosis and hemorrhage. CLINICAL PRESENTATION: A 50 year-old woman presented with recurrent headaches and was found to harbor a falcine meningioma. The patient elected to observe the mass and 13 months later she developed new neurological deficits. Prior to scheduled resection, she presented with abdominal pain and underwent emergent laparoscopic cholecystectomy. Two days after the procedure, she developed sudden right hemiparesis associated with severe headache. MRI of the brain showed an intratumoral wedge-shaped hypointense area with significant peritumoral edema. The patient was started on high-dose corticosteroids with considerable improvement in strength. INTERVENTION: The patient underwent a complete resection of the tumor with no new neurological deficits post-operatively. Histopathological analysis confirmed a WHO grade II atypical meningioma with extensive necrosis without hemorrhage. CONCLUSION: This case highlights that tumor infarction, although rare, should be in the differential diagnosis of patients with meningiomas presenting with new neurological deficits. When this condition is recognized and treated in timely manner with high-dose corticosteroids and surgical resection, patients can have favorable long-term outcomes.

Pure endoscopic removal of pineal region tumors.

PURPOSE: Endoscopic resection of pineal tumors using an endoscope with a mounted rigid suction that allows bimanual handling of the tumor for resection. This contrasts to the established method of biopsy of pineal tumors through intraventricular approach. METHODS: Two patients, one with a cystic lesion in the pineal region and one with a large pineal tumor, were operated in sitting position through a subtorcular approach. Endoscope was held in the left hand with suction tip extending beyond the tip through its instrument channel. Regular microsurgical instrumentation/CUSA/Nico Aspirator was used with the right hand for dissection, cutting, and removing the tumor under endoscopic vision. RESULT: Surgeon comfort was superior to when microscope is used in sitting position. Complete resection was achieved in all cases. CONCLUSION: The two-handed endoscopic technique using a mounted suction on the endoscope as described is a safe and effective strategy for resecting pineal region tumors.