Neonatal brain abscess development following fetal scalp electrode placement: a rare complication.

A fetal scalp electrode (FSE) is a frequently used investigation during labor. However, it is an invasive procedure which can lead to complications. Our patient developed a very large brain abscess after initial superficial infection of the skin site due to an FSE. The patient was admitted to the hospital after an asymmetric growth of the skull was noticed with no further signs of clinical illness. MRI showed a very large brain abscess which was aspirated and treated with antibiotics for 10 weeks. A 2-year follow-up showed only a slight developmental delay in gross motor skills. Only once before a similar case has been described at which the patient developed a brain abscess after superficial infection of the scalp following an FSE. In both cases, the brain abscess was noticed due to an asymmetric growth of the skull without any further signs of clinical illness. A brain abscess has a high mortality and morbidity rate, and early diagnosis is vital for the optimal outcome. We therefore recommend to organize an out-patient clinical follow-up for every infant with a superficial infection of the skin site after placement of an FSE.

[The current MRSA policy in the Netherlands is doing more harm than good]. / Het Nederlandse MRSA-beleid doet meer kwaad dan goed.

The current policy concerning methicillin-resistant Staphylococcus aureus (MRSA) in hospitals needs to be altered because there is no reliable proof that the isolation policy that is currently in force actually leads to any reduction in the prevalence of MRSA. Conversely, it has been proved that these isolation measures lead to poorer patient care, sometimes resulting in death.

Frameless stereotactic subcaudate tractotomy for intractable obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is a chronic, disabling disorder. Psychosurgery may be indicated for a subset of patients for whom no conventional treatment is satisfactory. This paper focuses on the stereotactic subcaudate tractotomy (SST). Thus far, these procedures have been carried out using frame-based stereotactic techniques. However, modern - highly accurate - frameless stereotactic procedures have successfully been introduced in neurosurgical practice. We developed a novel frameless stereotactic subcaudate tractotomy procedure with promising initial results in a patient suffering from intractable OCD. This is the first report on frameless SST. Future studies should examine whether other ablative stereotactic psychosurgery procedures can be done using frameless stereotactic methods.

The analysis of intraoperative neurosurgical instrument movement using a navigation log-file.

BACKGROUND: The purpose of this study was to define the technical requirements of future (tele)robotic neurosurgical systems. We aimed to analyse the movements of surgical instruments during neurosurgical procedures. METHODS: A commercially available neuronavigation system (StealthStation TREON(plus), Medtronic, USA) was used to determine the position and orientation of the surgical instrument. A custom-made log-mode was implemented in the software to file instrument coordinates intraoperatively. Data was collected during the debulking of malignant primary brain tumours, temporal epilepsy surgery and skull base tumour surgery. RESULTS: Maximum tip displacement velocity varied, per procedure, in the range 6.6-12.7 cm/s and maximum rotational speed 21-40 degrees/s. Maximum instrument orientation differences within the volume of movement varied. The largest differences were detected during temporal epilepsy surgery (73 degrees and 52 degrees in the coronal and axial planes, respectively), while the smallest differences were detected in the debulking of an intraventricular tumour. CONCLUSIONS: In this study, we have demonstrated the feasibility of motion analysis in image-guided neurosurgery. To mimic ordinary open neurosurgery, future neurosurgical (tele)robotic systems should at least support translational speeds up to 12.7 cm/s, rotational speeds up to 40 degrees/s and differences in instrument orientation of up to 73 degrees.

Frameless stereotactic placement of ventriculoperitoneal shunts in undersized ventricles: a simple modification to free-hand procedures.

The aim of this report is to introduce a simple modification to the free-hand frameless stereotactic placement of ventriculoperitoneal shunts in undersized ventricles. In this technical note, we describe our experience with ventricular catheter placement in two children suffering from shunt dependent idiopathic intracranial hypertension using an image-guided instrument holder with a catheter guide. In both patients, the surgical procedure proved to be easy and accurate, with good initial clinical results. The use of an image-guided instrument holder is a modification to the free-hand frameless stereotactic placement of ventriculoperitoneal shunts in undersized ventricles.