Aimée Redondo

Evaluation of the Management of Postoperative Aseptic Meningitis

BACKGROUND A consensus conference recommended empirical antibiotic therapy for all patients with postoperative meningitis and treatment withdrawal after 48 or 72 h if cerebrospinal fluid culture results are negative. However, this approach is not universally accepted and has not been assessed in clinical trials. METHODS We performed a cohort study of all patients who received a diagnosis of postoperative meningitis from January 1998 through May 2005 in a teaching hospital. From January 1998 through September 2003 (control period), guidelines were lacking or were not implemented. From October 2003 through May 2005 (interventional period), all patients received a predefined intravenous antibiotic therapy that was discontinued on the third day if the meningitis was considered aseptic. Clinical outcome and duration of antibiotic therapy were analyzed for each patient. RESULTS Seventy-five episodes of postoperative meningitis (21 cases of bacterial meningitis and 54 cases of aseptic meningitis) were investigated. Patients with aseptic meningitis received antibiotic treatment for a mean +/- standard deviation duration of 11+/-5 days during the control period and 3.5+/-2 days during the intervention period (P=.001). The duration of antibiotic treatment for bacterial meningitis was not significantly different between the 2 periods. All episodes of bacterial and aseptic meningitis were cured, and complications were rare during both periods. CONCLUSIONS Stopping antibiotic treatment after 3 days is effective and safe for patients with postoperative meningitis whose cerebrospinal fluid culture results are negative.

Tuberculoma of the Cavernous Sinus: Case Report

OBJECTIVE AND IMPORTANCE The cavernous sinus is an exceptional location for intracranial tuberculomas. A rapid diagnosis, based on pathological findings, improves the prognosis. CLINICAL PRESENTATION A case of left cavernous sinus tuberculoma, revealed by frontal headaches and ipsilateral palsies of Cranial Nerves III and V, in a 48-year-old patient is reported. The lesion mimicked an aggressive meningioma in radiological examinations. INTERVENTION The lesion was excised through a subtemporal approach. The diagnosis was based on the pathological examination of the mass. Postoperative antituberculous chemotherapy completed the treatment. Neurological symptoms regressed rapidly. CONCLUSION Although the incidence of intracranial tuberculomas is decreasing in developed countries, a high index of suspicion must be maintained for the diagnosis of intracranial masses in the presence of risk factors for tuberculosis.

Anterior skull base osteoid osteoma: case report

Osteoid osteoma is a benign bone tumour which rarely occurs in the skull. A case of such a tumour in the posterior ethmoid region bulging into the anterior cranial fossa is reported in a 42-year-old woman who presented with intense frontal headaches. Excision of the tumour was performed through a subfrontal approach.

Natural history of supratentorial hemangioblastomas in von Hippel-Lindau disease.

BACKGROUNDSupratentorial hemangioblastomas are rare lesions, occurring either sporadically or in von Hippel-Lindau disease. OBJECTIVEFollowing recent advances in our understanding of the natural history of von Hippel-Lindau–associated cerebellar and spinal hemangioblastomas, we conducted a study of the natural history of supratentorial hemangioblastomas in von Hippel-Lindau disease. METHODSWe reviewed a series of 18 supratentorial hemangioblastomas in 13 patients with von Hippel-Lindau disease. Clinical, genetic, and serial imaging data and operative records were analyzed. RESULTSHemangioblastomas were most commonly seen in the temporal lobe. Only 6 tumors had a cyst at diagnosis or during follow-up, and only 6 patients had associated symptoms at presentation or during follow-up. The most frequent clinical presentations were intracranial hypertension and visual loss. Of 14 tumors with documented serial imaging, 13 demonstrated tumor growth. Rates and patterns of tumor growth were unique to each patient. The mechanism of cyst formation described in other locations was also demonstrated in the supratentorial region. Patterns of peritumoral edema and rate of cyst formation seemed to be influenced by the presence of anatomic barriers. Germline VHL mutation was identified in all patients, but no specific genotype-phenotype correlation was found, although a familial predisposition is suggested. CONCLUSIONThis series illustrates the wide variation in tumor locations, patterns of growth, and edema progression seen in supratentorial hemangioblastomas and adds to our knowledge of the natural history of hemangioblastomas.

Opening cerebrospinal fluid pressure guides the management of cerebrospinal fluid leakage after acoustic neuroma surgery.

Objective: To assess the value of cerebrospinal fluid pressure as a decisional factor for immediate surgical revision in cerebrospinal fluid leakage after acoustic neuroma removal. Study Design: Prospective study. Setting: Tertiary referral center. Patients: Between 1998 and 2001, 220 patients were operated on for acoustic neuroma by different transpetrosal approaches. Among 24 patients (12%) presenting postoperative cerebrospinal fluid leakage, those with meningitis or with hydrocephalus were excluded. Fifteen patients were included in this study. Methods: Each patient had initial conservative treatment with serial depletive lumbar punctures and cerebrospinal fluid pressure measurements associated with oral acetazolamide. Surgical revision was decided on in case of persistent cerebrospinal fluid leakage. Results: In eight patients with high cerebrospinal fluid pressure (18 ± 1.4 cm H2O; range, 14–28 cm H2O), cerebrospinal fluid leak disappeared in 3 days after conservative treatment. Seven other patients required surgical revision for persistent cerebrospinal fluid leakage. Revision surgery was efficient in six patients with low cerebrospinal fluid pressure (8 ± 1.3 cm H2O, range, 3–12 cm H2O). In the remaining patient with high cerebrospinal fluid pressure (18 cm H2O), cerebrospinal fluid leakage continued despite surgical revision, requiring lumboperitoneal shunting. Conclusion: The cerebrospinal fluid pressure value may be used as a decisional indicator for cerebrospinal fluid leakage treatment after acoustic neuroma surgery. Low cerebrospinal fluid pressure leakage would imply a revision surgery procedure without delay, whereas high cerebrospinal fluid pressure leakage would imply conservative treatment.

Méningiome lipomateux : À propos de deux cas

Resume Le meningiome lipomateux est une entite rare appartenant au groupe des meningiomes metaplasiques selon la classification de l’Organisation Mondiale de la Sante (OMS). Nous en rapportons deux cas, l’un revele par des cephalees et l’autre par une crise comitiale. En imagerie, ces tumeurs etaient extra-axiales et uniques. Une de ces tumeurs apparaissait riche en graisse alors que l’autre ne differait pas d’un meningiome classique. Histologiquement, il s’agissait de deux meningiomes, l’un meningothelial et l’autre transitionnel, renfermant, dans des proportions variables, une composante adipeuse d’aspect mature ou immature. La quantite de cellules surchargees en lipides etait tres importante dans un cas et beaucoup plus moderee dans l’autre, expliquant ainsi les donnees de l’imagerie. Il n’y avait pas de critere histologique d’atypie. Les cellules meningotheliales et les cellules presentant une morphologie d’adipocyte mature ou de lipoblaste exprimaient l’antigene de membrane epitheliale et les recepteurs a la progesterone. Ces resultats immunohistochimiques sont donc plutot en faveur d’une modification des cellules meningotheliales avec surcharge lipidique que d’une veritable metaplasie.

Thoracic spine osteoid osteoma

Abstract A case report of an adult patient with an osteoid osteoma of the lamina of 9th thoracic vertebra is presented. The long history of progressively worsening nocturnal dorsal pain which was relieved by non-steroid anti-inflammatory drugs, and an essentially clinical examination, are typical of this condition in which the CT and radionuclide bone scans are the investigation of choice. Complete relief was obtained following excision of the lesion. The literature is reviewed.

Long-term follow-up of an infratentorial primary paraganglioma: a case report

We report a case of infratentorial primary paraganglioma for which we have a 10-year incomplete pretreatment clinical and radiological follow-up. Partial surgical removal followed by external radiotherapy resulted in stable disease at 6 years follow-up. We compare our patients case with similar cases reported in the literature.