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Management of Neurosurgical Complications
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Neurological Disorders

ISSN: 2329-6895

Open Access

Management of Neurosurgical Complications

Case Report

Pages: 1 - 2

A Rare Case of Familial Multiple Sclerosis

Rima R

Multiple sclerosis (MS) is a chronic disease confined to the central nervous system (CNS). Its pathological hallmarks are neuroinflammation, de- and remyelination, neurodegeneration and astrogliosis. This neuroinflammation disrupts the neurological circuits, resulting in a varied signs and symptoms including physical, cognitive and psychiatric problems. MS occurs either in relapsing form or in progressive form.

Research Article

Pages: 1 - 4

Lamotrigine-Related Severe Cutaneous Adverse Reaction in Patient with Epilepsy

Al-Quliti KW and Al-Amri MS

Background: Epilepsy is a common neurological disorder for which lamotrigine is an effective antiepileptic medication as monotherapy or as an add-on therapy with good tolerability and safety profile. Side effects, including serious skin reactions, can develop during treatment with lamotrigine and can be life threatening. The aim of this research is to study the local experience of adult Saudi patients with epilepsy who developed lamotrigine-related skin reactions.
Methods: This observational retrospective study included all epilepsy patients who received lamotrigine and were followed up in the adult epilepsy clinic at King Fahad Hospital, Madinah, Saudi Arabia, between July 2011 and June 2014.
Results: A total of 147 epilepsy patients received lamotrigine. Eleven patients (7.48%), aged 24 to 62 years old (mean 39.73 SD 11), of which 6 were male (54.5%) and 5 female (45.5%), developed cutaneous adverse drug reactions. Lamotrigine was used as monotherapy in one patient and as add-on therapy for 10 patients. Eight patients (72.73%) had high liver enzymes. Seven patients (63.6%) had systemic symptoms. Cutaneous adverse drug reactions were noted 1 to 4 weeks after lamotrigine initiation (mean=2.36, mode=3); 7 patients (63.63%) had maculopapular rashes, and 4 patients (36.37%) had urticaria. Six patients (54.5%) had good recovery; 1 patient developed sepsis; 2 patients developed hyperpigmentations; and 2 patients developed drug reactions with eosinophilia and systemic symptoms. Conclusion: Lamotrigine is an effective medication for management of epilepsy and other nervous system disorders, with a good tolerability and safety profile. However, lamotrigine-related cutaneous adverse drug reactions can be serious and healthcare providers’ thorough clinical knowledge of the potential side effects of lamotrigine is crucial in clinical practice particularly when patients receive multiple antiepileptic drugs.

Case Report

Pages: 1 - 6

Facial Reanimation Via ?Free Gracilis Muscle Vascularised Graft(FGMVG) after Remodelling Resection (RR) in Recurrent Orbitofrontal Fibrous Dysplasia (ROFFD) with Skull Base Extension- Review of Literature

Tripathy SR, Mohanta I, Mishra SS and Satapathy MC

Background: Fibrous dysplasia (FD) is an abnormal bony lesion of unknown aetiology with insufficient bone maturation and fibrous tissue replacement. It can affect any bone but maxilla is most commonly affected facial bone. Affection of craniofacial bones with skull base involvement, though rare, is important for neurosurgeons. Orbital invasion is very rare. Diagnosis is late due to nonspecific symptoms, low suspicion and relative rarity. Polyostotic FD grows very rapidly and is frequently associated with deformities, complications and recurrence.
Case report: A 35 year old male presented with painful tender swelling, chronic discharging sinus, skin defect and foul smelling discharge over the previous operated site of left fronto - orbital region. He also had 2 episodes of generalised tonic clonic convulsions. He was operated for left frontal FD 15 yrs back. The current CT scan revealed a solid lesion in the left fronto-ethmoido-orbital region extending to skull base with left frontal lobar compression. He underwent a two stage surgery; first for surgical excision of diseased bone and after 1 month for filling the bony defect with gracillis muscle free vascular graft (FGMVG), anatomising with the superficial temporal vessels. Biopsy confirmed disorganized and immature bone. Patient’s symptoms got resolved with improvement of the facial deformity.
Conclusion: Craniofacial fibrous dysplasia involving orbit and skull base is a very rare osteopathy. Re-do surgery may be required even after an interval of one and a half decade. In extensive literature research, ROFFD treated with FGMVG couldn’t be traced. So this may be a first such case report; adding to the armamentarium of the Neurosurgeons and craniofacial surgeons in the fight against this dreaded disease.

Case Report

Pages: 1 - 2

A Case of Episodic Ataxia Type-2 with a Novel Gene Mutation and Complex Phenotype

Rossi FH

We report the case of 66-year-old male with episodic ataxia type 2 carrying a novel CACNA1A gene mutation affected with a new and heterogeneous phenotype. The patient presented with intermittent episodes of ataxia, dysarthria, and vertigo since childhood. The patient also had atypical features of perioral numbness, right facial drooling, and bilateral upper limb action tremor. The cerebellar ataxia episodes significantly increased in frequency with age, but entirely remitted with acetazolamide treatment.

Research Article

Pages: 1 - 3

Experiences with the Sitting Position in Posterior Fossa Surgery in 310 Patients

Heymanns V, Jung S, Tallo A, Cheko A, Alyeldien A, Tsogkas A, Doukas A, Daemi-Attaran P, Alsharif M, Mahvash M, Scholz M and Petridis AK

Introduction: The sitting position for lesions in the posterior fossa has been controversially discussed in the literature because of high risk of air embolism. We report our experience with the sitting position and evaluate the risk of air embolism.
Material and Methods: We performed a retrospective analysis of patient charts (N=310), surgical and anesthesiological reports to evaluate the occurrence of intraoperative complications. Pre and post-operative MRIs were also evaluated for occurrence of embolic infarctions. The patients were operated in our department from 2009–2013.
Results: Only 0.6% of patients suffered from embolic infarctions. Most of the complications were similar to the complications which occur in the lateral oblique position. Preoperatively, all patients were evaluated with echocardiography to exclude a patent foramen ovale (those patients were not operated in the sitting position).
Conclusion: The sitting position is excellent for surgery in the posterior fossa since blood is washed out and does not intervene with the surgical field. The risk of air embolism is very low when a patent foramen ovale has been excluded. Intraoperatively, a right ventricular catheter is inserted to aspirate air if needed. Meticulous coagulation, irrigation of the surgical domane and application of bone wax to the craniotomy edges reduces the risk of venous air embolism.

Research Article

Pages: 1 - 3

Avoiding Pneumocephalus after Chronic Subdural Hematoma Evacuation: The Temporary Double Drainage Technique

Cecchini G

Aim: Chronic subdural hematoma presents an increasing challenge as the population ages. Despite the plethora of surgical techniques described, a high recurrence rate is still encountered. One of the possible risk factor for recurrence is post-operative pneumocephalus. The technique described is focused on avoiding post-operative pneumocephalus and obtaining complete hematoma evacuation.
Methods: We describe a simple surgical technique consisting of a temporary double air-fluid inverse drainage. Results: The technique proposed in this paper allows the complete evacuation of the hematoma fluid and, at the same time, the removal of intracranial air employing the same devices normally used in the standard procedure.
Conclusion: The technique proposed in this paper is safe, simple and could be highly effective

Image

Pages: 1 - 1

MR Imaging of Teflon Induced Granuloma as a Cause of Recurrent Trigeminal Neuralgia Following Microvascular Decompression

Soni N and Sunil K

Teflon is an inert material used for microvascular decompression and placed between the trigeminal nerve and offending vessel. Teflon granuloma is considered a less known cause for recurrent facial pain after MVD. Here we report our experience with Teflon ganuloma and its treatment.

Editorial

Pages: 1 - 1

Diabetes and Metabolic Syndrome Can Contribute to Recurrent Vascular Events in Patients with Lacunar Stroke?

Roever L and Resende ES

Lacunar stroke corresponds to 15-25% of all ischemic strokes, and has a more favorable prognosis and their survival rates at 30 days and 1 year are about 90-100%, and about 70-80% patients are functionally independent at 1 year, compared with less than 50% of patients with non-lacunar stroke.

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