Postoperative cervical cord compression induced by hydrogel (DuraSeal): a possible complication.

STUDY DESIGN: A retrospective case report. OBJECTIVE: To raise the issue of DuraSeal for dural tear repair; to raise the issue of the potential for fatal consequences, if not considered to be an issue around and after surgery; and to illustrate this with a case. SUMMARY OF BACKGROUND DATA: Cerebrospinal fluid leak is a potential complication of spinal, and posterior fossa surgery. Leakage may be caused by inadvertent dural tears during decompressive laminectomy or extradural spinal approaches, for spinal surgery. We present the case of a complication as a result of repair for dural tear with hydrogel. METHODS: History, focused neurologic examination with pre- and postoperative magnetic resonance scan images. RESULTS: C5-C6 anterior cervical discectomy, and fusion with a standard commercial PEEK space cage. Intraoperatively there was a small cerebrospinal leak when excising the posterior longitudinal ligament. Surgicel and DuraSeal were used to seal this. The patient developed a quadriparesis after surgery which was a result of expansion of the hydrogel seen on MRI and at re-exploration. CONCLUSION: Hydrogel is now described for the second time to cause potentially fatal expansion.

Discovery, development, and clinical application of sugammadex sodium, a selective relaxant binding agent.

Neuromuscular blockade, induced by neuromuscular blocking agents, has allowed prescribed immobility, improved surgical exposure, optimal airway management conditions, and facilitated mechanical ventilation. However, termination of the effects of neuromuscular blocking agents has, until now, remained limited. A novel cyclodextrin encapsulation process offers improved termination of the paralytic effects of aminosteroidal non-depolarizing neuromuscular blocking agents. Sugammadex sodium is the first in a new class of drug called selective relaxant binding agents. Currently, in clinical trials, sugammadex, a modified gamma cyclodextrin, has shown consistent and rapid termination of neuromuscular blockade with few side effects. The pharmacology of cyclodextrins in general and sugammadex in particular, together with the results of current clinical research are reviewed. The ability of sugammadex to terminate the action of neuromuscular blocking agents by direct encapsulation is compared to the indirect competitive antagonism of their effects by cholinesterase inhibitors. Also discussed are the clinical implications that extend beyond fast, effective reversal, including numerous potential perioperative benefits.

Is surgical intervention frequently required for medically managed macroprolactinomas? A study of spontaneous cerebrospinal fluid rhinorrhea.

BACKGROUND: The frequency of spontaneous CSF rhinorrhea in macroprolactinoma patients is poorly documented and was previously thought to be a very rare occurrence. METHODS: Thirty patients with macroprolactinomas (>1.0 cm diameter) identified from the Swansea neuroendocrine database were studied retrospectively. RESULTS: At presentation, the median serum prolactin was 28,354 (range, 1844 to >6,000,000) mU/L; radiologically, 4 adenomas were invading the cavernous sinus, one the sphenoid sinus and 5 both the cavernous and sphenoid sinus. After commencement of medical therapy, 4 subjects developed CSF rhinorrhea requiring surgical correction; all 4 had tumors invading both the cavernous and sphenoid sinus and an initial serum prolactin more than 75,000 mU/L. One subject developed an acute psychosis, and a man who presented with delayed puberty committed a serious sexual offense. CONCLUSIONS: Serious adverse effects are not uncommon in medically treated macroprolactinoma patients. Subjects with adenomas invading the sphenoid sinus have a high risk of developing CSF rhinorrhea that requires neurosurgical intervention.

Isolated chorda tympani injury following petrous temporal fracture.

Petrous temporal fractures account for nearly a fifth of all skull base fractures but are associated with taste disturbance in only 2% of cases. Chorda tympani injuries almost invariably occur in association with other nerve injuries. We present a rare case of an isolated chorda tympani injury associated with a petrous temporal fracture. Our observations suggest that the gustatory fibres in this nerve are segregated into groups subserving different taste modalities.

Recurrent carpal tunnel syndrome owing to an implantation epidermoid cyst after carpal tunnel decompression: case report.

OBJECTIVE: Implantation epidermoid cysts have been reported after a variety of surgical procedures. Although carpal tunnel surgery is the most common peripheral nerve operation, there have been no previous reports of these cysts after carpal tunnel decompression. We present a case of an implantation epidermoid cyst after carpal tunnel surgery. CLINICAL PRESENTATION: A 41-year-old man presented with recurrence of carpal tunnel syndrome and an enlarging mass at the site of his previous carpal tunnel decompression. INTERVENTION: The operation site was re-explored, and a subcutaneous mass was removed. This was histologically shown to be an implantation epidermoid cyst. CONCLUSION: The possibility of an implanted epidermoid cyst should be considered in any patient who presents with a recurrence of carpal tunnel symptoms and a mass at the site of the previous operation. It is possible that the occurrence of these cysts may be related to the use of polyglactin sutures for wound closure. In this case, the result of surgery was excellent.

Ganglioglioma with anaplastic recurrence of the neuronal element following radiotherapy.

Gangliogliomas are rare tumours in adults representing between 0.5% and 1% of all neuroepithelial tumours. They are of mixed cellularity comprised both of a neuronal and a glial population. Although malignant transformation is rare, and this mostly occurs in the glial element, we present a case of malignant neuroblastomatous transformation of a ganglioglioma. This is only the second ever case to our knowledge in the literature reporting the participation of the neuronal element in the malignant transformation of a ganglioglioma. In contrast with the previous published case, our patient has received post-operative therapeutic radiotherapy. The related literature is reviewed and the oncogenic role of therapeutic irradiation is discussed.

CSF diversion in benign intracranial hypertension using a lumbo-atrial shunt.

An obese woman with benign intracranial hypertension had been managed for several years with lumbo-peritoneal shunting. Following a bilopancreatic procedure performed for management of her obesity dense peritoneal adhesions caused repeated shunt failure. The shunt system was successfully converted to a lumbo-atrial system.