Objectives: We critically reviewed our experiences in endocranial complications with Functional Endoscopic Sinus Surgery, and investigated the causes, prevention strategies and management. Methods: We conducted a retr...Objectives: We critically reviewed our experiences in endocranial complications with Functional Endoscopic Sinus Surgery, and investigated the causes, prevention strategies and management. Methods: We conducted a retrospective study of endocranial complications with Functional Endoscopic Sinus Surgery performed during last 10 years in our ENT department. We analyzed endocranial complications, their causes, consequences, treatments and outcomes. Management was performed in collaboration with neurosurgeons and infectious diseases specialists. Results: Of 763 Functional Endoscopic Sinus Surgery procedures, we identified three cases with endocranial complications (0.393%). These complications included: a case of postoperative severe cerebrospinal fluid leak in a patient treated for severe polyposis;a case of cerebral-frontal abscess with delayed clinical manifestation (4 weeks post-surgery) in a patient treated for chronic pansinusitis who experienced difficult surgery for septal spur;and a case of pneumocephalus in a patient treated for allergic fungal sinusitis. The clinical outcome was favorable in all cases. Conclusions: Intra-operative cerebrospinal fluid leak, anatomical deformities (even minimal deformities) and massive inflammatory sinus disease are predisposing factors for endocranial complications with Functional Endoscopic Sinus Surgery. Prognosis can be favorable when therapeutic management is carried out in collaboration with neurosurgeons and infectious disease specialists.展开更多
Halo fixation devices are often employed for critically ill or trauma patients with unstable cervical pathologies. These include fractures, spinal decompression and reconstruction procedures. However, the critical car...Halo fixation devices are often employed for critically ill or trauma patients with unstable cervical pathologies. These include fractures, spinal decompression and reconstruction procedures. However, the critical care literature has surprisingly little information in regard to associated complications. Perry and Nickel pioneered the initial halo device in 1959 and soon afterward recognized complications associated with its use [1]. They developed a detailed regimen to prevent abnormal pin placement and infections. The details include pin placement in “safe” zones, specific degrees of torque, and techniques to minimize infection risk. Despite a low death rate, a cerebral brain abscess often leads to prolonged neurological morbidity [2]. Seizures and pneumocranium have also been ascribed to intracranial penetration of halo pins [3,4]. The following describes a patient with cerebral abscess secondary to halo pin penetration. He then developed several other associated complications during hospitalization.展开更多
A retrospective evaluation of 42 cases of podiatric brain abscess from 1985 to 1994 was performed. All patients were diagnosed by characteristic contrast-enhancement on CT scan.39 cases did not give a history of infec...A retrospective evaluation of 42 cases of podiatric brain abscess from 1985 to 1994 was performed. All patients were diagnosed by characteristic contrast-enhancement on CT scan.39 cases did not give a history of infection. The maximum diameter of the enhancement area was 2. 2cm Epileptic seizures were usually the initial and main symptoms,but local neurological signs werr absent.All of the cases were treated by antibiotic therapy.The duration of the therapy in most childhood patients was 2 ̄3 months,3 were over 3 months. They were followed up 1 ̄7 years after acute illness.Neurological sequelae were diagnosed in 3 of 42 cases.展开更多
文摘Objectives: We critically reviewed our experiences in endocranial complications with Functional Endoscopic Sinus Surgery, and investigated the causes, prevention strategies and management. Methods: We conducted a retrospective study of endocranial complications with Functional Endoscopic Sinus Surgery performed during last 10 years in our ENT department. We analyzed endocranial complications, their causes, consequences, treatments and outcomes. Management was performed in collaboration with neurosurgeons and infectious diseases specialists. Results: Of 763 Functional Endoscopic Sinus Surgery procedures, we identified three cases with endocranial complications (0.393%). These complications included: a case of postoperative severe cerebrospinal fluid leak in a patient treated for severe polyposis;a case of cerebral-frontal abscess with delayed clinical manifestation (4 weeks post-surgery) in a patient treated for chronic pansinusitis who experienced difficult surgery for septal spur;and a case of pneumocephalus in a patient treated for allergic fungal sinusitis. The clinical outcome was favorable in all cases. Conclusions: Intra-operative cerebrospinal fluid leak, anatomical deformities (even minimal deformities) and massive inflammatory sinus disease are predisposing factors for endocranial complications with Functional Endoscopic Sinus Surgery. Prognosis can be favorable when therapeutic management is carried out in collaboration with neurosurgeons and infectious disease specialists.
文摘Halo fixation devices are often employed for critically ill or trauma patients with unstable cervical pathologies. These include fractures, spinal decompression and reconstruction procedures. However, the critical care literature has surprisingly little information in regard to associated complications. Perry and Nickel pioneered the initial halo device in 1959 and soon afterward recognized complications associated with its use [1]. They developed a detailed regimen to prevent abnormal pin placement and infections. The details include pin placement in “safe” zones, specific degrees of torque, and techniques to minimize infection risk. Despite a low death rate, a cerebral brain abscess often leads to prolonged neurological morbidity [2]. Seizures and pneumocranium have also been ascribed to intracranial penetration of halo pins [3,4]. The following describes a patient with cerebral abscess secondary to halo pin penetration. He then developed several other associated complications during hospitalization.
文摘A retrospective evaluation of 42 cases of podiatric brain abscess from 1985 to 1994 was performed. All patients were diagnosed by characteristic contrast-enhancement on CT scan.39 cases did not give a history of infection. The maximum diameter of the enhancement area was 2. 2cm Epileptic seizures were usually the initial and main symptoms,but local neurological signs werr absent.All of the cases were treated by antibiotic therapy.The duration of the therapy in most childhood patients was 2 ̄3 months,3 were over 3 months. They were followed up 1 ̄7 years after acute illness.Neurological sequelae were diagnosed in 3 of 42 cases.