scholarly journals Pathogenetic variants of ventriculitis in children

2020 ◽  
Vol 12 (4) ◽  
pp. 37-44
Author(s):  
A. S. Pozhivil ◽  
A. Yu. Shcherbuk ◽  
A. P. Lyapin ◽  
Yu. A. Shcherbuk
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Shunt Infection ◽  
Multidrug Resistant ◽  
External Ventricular Drainage ◽  
Clinical Findings ◽  
Adverse Outcomes ◽  
Cerebrospinal Fluid Leakage ◽  
Diagnostic Features ◽  
Systemic Infections

The aim of the study: to analyze the pathogenetic structure of ventriculitis, their relationship with age, risk factors, study the etiological characteristics, clinical and diagnostic features, evaluate outcomes of ventriculitis and features of mortality.Materials and methods: a retrospective analysis of inpatient medical charts of 72 children with ventriculitis received treatment in the neurosurgery department of Filatov Children hospital №5, St-Petersburg, from January 2008 to December 2017 was carried out.Results: Most cases of ventriculitis occurred in infants (up to 1 year) and young children (1-3 years old). The largest group among pathogenetic variants of ventriculitis was shunt infection – 50 (69.44%) cases. Other groups were: ventriculostomy-associated ventriculitis – 12 (16,67%) cases; ventriculitis following a neurosurgical procedure without external ventricular drainage – 6 (8,33%) cases; ventriculitis complicated meningitis in patients without prior neurosurgery – 4 (5,56%) cases. The presence of such risk factors for ventriculitis as cerebrospinal fluid leakage (18,06%), intraventricular blood prior to the development of ventriculitis (22,22%), and other systemic infections (59,72%) were noted. The crucial role in the diagnosis of ventriculitis is played by the inflammatory changes in the ventricular cerebrospinal fluid on the background of specific clinical findings and indicative anamnesis. The commonest organism causing ventriculitis in the study was Staphylococcus epidermidis – 24 (33,33%) patients. Ventriculitis mortality rate was 8,33% (6 cases). Analysis of adverse outcomes revealed that aggressive health-care-associated multidrug resistant organisms are more dangerous for life, especially in patients with severe central nervous system pathology prior to ventriculitis.

scholarly journals Cerebrospinal fluid leakage after cranial surgery in the pediatric population—a systematic review and meta-analysis

2021 ◽  
Author(s):  
Emma M. H. Slot ◽  
Kirsten M. van Baarsen ◽  
Eelco W. Hoving ◽  
Nicolaas P. A. Zuithoff ◽  
Tristan P. C van Doormaal
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Cerebrospinal Fluid ◽  
Pediatric Population ◽  
Meta Analysis ◽  
Leakage Rate ◽  
Csf Leak ◽  
Cerebrospinal Fluid Leakage ◽  
Cranial Surgery ◽  
Csf Leakage

Abstract Background Cerebrospinal fluid (CSF) leakage is a common complication after neurosurgical intervention. It is associated with substantial morbidity and increased healthcare costs. The current systematic review and meta-analysis aim to quantify the incidence of cerebrospinal fluid leakage in the pediatric population and identify its risk factors. Methods The authors followed the PRISMA guidelines. The Embase, PubMed, and Cochrane database were searched for studies reporting CSF leakage after intradural cranial surgery in patients up to 18 years old. Meta-analysis of incidences was performed using a generalized linear mixed model. Results Twenty-six articles were included in this systematic review. Data were retrieved of 2929 patients who underwent a total of 3034 intradural cranial surgeries. Surprisingly, only four of the included articles reported their definition of CSF leakage. The overall CSF leakage rate was 4.4% (95% CI 2.6 to 7.3%). The odds of CSF leakage were significantly greater for craniectomy as opposed to craniotomy (OR 4.7, 95% CI 1.7 to 13.4) and infratentorial as opposed to supratentorial surgery (OR 5.9, 95% CI 1.7 to 20.6). The odds of CSF leakage were significantly lower for duraplasty use versus no duraplasty (OR 0.41 95% CI 0.2 to 0.9). Conclusion The overall CSF leakage rate after intradural cranial surgery in the pediatric population is 4.4%. Risk factors are craniectomy and infratentorial surgery. Duraplasty use is negatively associated with CSF leak. We suggest defining a CSF leak as “leakage of CSF through the skin,” as an unambiguous definition is fundamental for future research.

scholarly journals Incidence and Risk Factors for Symptomatic Spinal Epidural Hematoma Following Posterior Thoracic Spinal Surgery in a Single Institute

2020 ◽  
pp. 219256822097914
Author(s):  
Longjie Wang ◽  
Hui Wang ◽  
Zhuoran Sun ◽  
Zhongqiang Chen ◽  
Chuiguo Sun ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Spinal Surgery ◽  
Cerebrospinal Fluid Leakage ◽  
Sectional Area ◽  
Kyphosis Angle ◽  
Cross Sectional ◽  
Thoracic Spinal ◽  
Local Kyphosis ◽  
Spinal Epidural

Study Design: Case-control study. Objectives: To investigate the incidence of symptomatic spinal epidural hematoma (SSEH) and recognize its risk factors in a cohort of patients undergoing posterior thoracic surgery in isolation. Methods: From January 2010 to December 2019, patients who developed SSEH after posterior thoracic surgery and underwent hematoma evacuation were enrolled. For each SSEH patient, 2 or 3 controls who did not develop SSEH and underwent the same procedures with similar complexity at the same section of the thoracic spine in the same period were collected. The preoperative and intraoperative factors, blood pressure-related factors and radiographic parameters were collected to identify possible risk factors by comparing between the 2 groups. Results: A total of 24 of 1612 patients (1.49%) were identified as having SSEH after thoracic spinal surgery. Compared to the control group (53 patients), SSEH patients had significant differences in the APTT (p = 0.028), INR (p = 0.009), ratio of previous spinal surgery (p = 0.012), ratio of cerebrospinal fluid leakage (p = 0.004), thoracic kyphosis (p<0.05), local kyphosis angle (p<0.05), epidural fat ratio at T7 (p = 0.003), occupying ratio of the cross-sectional area (p<0.05) and spinal epidural venous plexus grade (p<0.05). Multiple logistic regression analysis revealed 3 risk factors for SSEH: cerebrospinal fluid leakage, the local kyphosis angle (>8.77°) and the occupying ratio of the cross-sectional area (>49.58%). Conclusions: The incidence of SSEH was 1.49% in posterior thoracic spinal surgeries. Large local kyphosis angle (>8.77°), high occupying ratio of cross-sectional area (>49.58%) and cerebrospinal fluid leakage were identified as risk factors for SSEH.

scholarly journals Development and Validation of Nomogram to Preoperatively Predict Intraoperative Cerebrospinal Fluid Leakage in Endoscopic Pituitary Surgery: A Retrospective Cohort Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Xiangming Cai ◽  
Junhao Zhu ◽  
Jin Yang ◽  
Chao Tang ◽  
Feng Yuan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Prediction Model ◽  
Calibration Curve ◽  
Validation Cohort ◽  
Laboratory Data ◽  
Pituitary Surgery ◽  
Cerebrospinal Fluid Leakage ◽  
Training Cohort ◽  
Preoperative Prediction

BackgroundPituitary adenomas (PAs) are the most common tumor of the sellar region. PA resection is the preferred treatment for patients with clear indications for surgery. Intraoperative cerebrospinal fluid (iCSF) leakage is a major complication of PA resection surgery. Risk factors for iCSF leakage have been studied previously, but a predictive nomogram has not yet been developed. We constructed a nomogram for preoperative prediction of iCSF leakage in endoscopic pituitary surgery.MethodsA total of 232 patients who underwent endoscopic PA resection at the Department of Neurosurgery in Jinling Hospital between January of 2018 and October of 2020 were enrolled in this retrospective study. Patients treated by a board-certified neurosurgeon were randomly classified into a training cohort or a validation cohort 1. Patients treated by other qualified neurosurgeons were included in validation cohort 2. A range of demographic, clinical, radiological, and laboratory data were acquired from the medical records. The Least Absolute Shrinkage and Selection Operator (LASSO) algorithm and uni- and multivariate logistic regression were utilized to analyze these features and develop a nomogram model. We used a receiver operating characteristic (ROC) curve and calibration curve to evaluate the predictive performance of the nomogram model.ResultsVariables were comparable between the training cohort and validation cohort 1. Tumor height and albumin were included in the final prediction model. The area under the curve (AUC) of the nomogram model was 0.733, 0.643, and 0.644 in training, validation 1, and validation 2 cohorts, respectively. The calibration curve showed satisfactory homogeneity between the predicted probability and actual observations. Nomogram performance was stable in the subgroup analysis.ConclusionsTumor height and albumin were the independent risk factors for iCSF leakage. The prediction model developed in this study is the first nomogram developed as a practical and effective tool to facilitate the preoperative prediction of iCSF leakage in endoscopic pituitary surgery, thus optimizing treatment decisions.

Analysis of Risk Factors of Intracranial Infection After Traumatic Brain Injury Surgery

2021 ◽  
Vol 7 (5) ◽  
pp. 3161-3167
Author(s):  
JiNan Li ◽  
XinLi Zhang ◽  
Hang SU ◽  
YaNan Qu ◽  
MeiXuan Piao
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Mechanical Ventilation ◽  
Cerebrospinal Fluid ◽  
Brain Injury ◽  
Operation Time ◽  
Cerebrospinal Fluid Leakage ◽  
Infection Group ◽  
Intracranial Infection ◽  
Indwelling Time

Background: Craniocerebral operation is the main method for the treatment of traumatic brain injury. However, it is very easy to be complicated with intracranial infection after operation, which affects the surgical efficacy and patient’s prognosis. It is also the main cause of surgical failure. It may also cause patient’s death for some patients with serious diseases. It is found that the infection after craniocerebral operation is often accompanied with abnormal changes of body-related treatment, in which the changes of serological indicators are more significant. Therefore, it is helpful to provide guidance for the prevention and judgment of patient’s postoperative infection by analyzing the patient’s serological indicators. Objective: To investigate the risk factors of intracranial infection and the levels of serum procalcitonin (PCT) and endothelin-1 (ET-1) in patients after traumatic brain injury. Methods: From January 2018 to January 2021, 58 patients with intracranial infection after traumatic brain injury (infection group) were selected, and 116 patients without intracranial infection after traumatic brain injury (non-infection group) were selected. The difference of clinical data between the two groups was analyzed. Serum PCT and ET-1 levels were measured in the two groups. Results: In the infection group, admission GCS scoring <8 points, operation time ≥4h, indwelling time of drainage tube ≥ 2d, preoperative ALB <35g/ L, mechanical ventilation and cerebrospinal fluid leakage were 63.79%, 72.41%, 43.10%, 68.97%, 32.76% and 68.97% respectively, which were obviously higher than those in the non-infection group (P<0.05). Logistic regression analysis results showed that admission GCS scoring, operation time, indwelling time of drainage tube, preoperative ALB, mechanical ventilation and cerebrospinal fluid leakage were the influencing factors of intracranial infection after traumatic brain injury (OR = 0.712,1.556,1.451,0.641,1.954 and 1.667, P<0.05); serum PCT and ET-1 in the infection group were (0.83 ± 0.20) mg/L and (0.87 ± 0.23) ng/L, respectively, which were significantly higher than those in the non-infection group (P<0.05); serum PCT and ET-1 in patients with different sex, age and pathogen had no significant difference (P>0.05); serum PCT and ET-1 area under ROC curve were 0.828 and 0.751, respectively P<0.05. Conclusion: The intracranial infection of patients with traumatic brain injury are affected by many factors including, admission GCS scoring, operation time, and so on, the levels of serum PCT and ET-1 in patients with intracranial infection are increased, which may be useful in predicting intracranial infection.

Incidence and risk factors of subdural hematoma after intraoperative cerebrospinal fluid leakage during the transsphenoidal approach

Pituitary ◽  
2016 ◽  
Vol 19 (6) ◽  
pp. 565-572 ◽  
Author(s):  
Kazuhito Takeuchi ◽  
Tadashi Watanabe ◽  
Tetsuya Nagatani ◽  
Yuichi Nagata ◽  
Jonsu Chu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Subdural Hematoma ◽  
Transsphenoidal Approach ◽  
Cerebrospinal Fluid Leakage ◽  
Fluid Leakage

scholarly journals Ceftaroline Cerebrospinal Fluid Penetration in the Treatment of a Ventriculopleural Shunt Infection: A Case Report

2020 ◽  
Vol 25 (4) ◽  
pp. 336-339
Author(s):  
Jeffrey J. Cies ◽  
Wayne S. Moore ◽  
Adela Enache ◽  
Arun Chopra
Keyword(s):  
Cerebrospinal Fluid ◽  
Case Reports ◽  
Fluid Collection ◽  
Rabbit Model ◽  
Shunt Infection ◽  
Adverse Outcomes ◽  
Pharmacokinetic Data ◽  
Ceftaroline Fosamil ◽  
Csf Penetration ◽  
History Of

Pharmacokinetic data regarding ceftaroline fosamil (CPT) penetration into cerebrospinal fluid (CSF) are limited to a rabbit model (15% inflamed) and adult case reports. We describe serum and CSF CPT concentrations in a 21-year-old, 34.8 kg female, medically complex patient presented with a 4-day history of fevers (Tmax 39.2°C), tachypnea, tachycardia, fatigue, and a 1-week history of pus and blood draining from the ventriculopleural (VPL) shunt. A head CT and an ultrasound of the neck revealed septated complex fluid collection surrounding the shunt. Therapy was initiated with vancomycin and ceftriaxone. Blood and CSF cultures from hospital day (HD) 1 were positive for methicillin-resistant Staphylococcus aureus with a CPT MIC of 0.5 mg/L and a vancomycin MIC range of 0.5 to 1 mg/L. On HD 3, CPT was added. On HD 7, simultaneous serum (69.4, 44, and 30.2 mg/L) and CSF (1.7, 2.3, and 2.3 mg/L) concentrations were obtained at 0.25, 1.5, and 4.75 hours from the end of an infusion. Based on these concentrations, CPT CSF penetration ratio ranged from 2.4% to 7.6%. After addition of CPT, the blood and CSF cultures remained negative on a regimen of vancomycin plus CPT. On HD 14, a new left-sided VPL shunt was placed. The patient continued on CPT for a period of 7 days after the new VPL shunt placement. This case demonstrated CPT CSF penetration in a range of 2.4% to 7.6%, approximately half of the rabbit model. This allowed for CSF concentrations at least 50% free time &gt; 4 to 6× MIC of the dosing interval with a dosing regimen of 600 mg IV every 8 hours in a 34.8 kg chronic patient and resulted in a successful clinical outcome with no identified adverse outcomes.

scholarly journals Single and Repeated Episodes of Candida Species Isolated From Cerebrospinal Fluid for Diagnosing Probable Candida meningitis

2021 ◽  
Vol 12 ◽  
Author(s):  
Lijun Xu ◽  
Handan Zhao ◽  
Minghan Zhou ◽  
Guanjing Lang ◽  
Haiyan Lou
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Odds Ratio ◽  
Mortality Rates ◽  
External Ventricular Drainage ◽  
Antifungal Treatment ◽  
Radiological Imaging ◽  
Vp Shunt ◽  
Factors Associated ◽  
Significant Difference

Background: The clinical relevance of single or repeated episodes of Candida spp. in cerebrospinal fluid (CSF) in adult patients is debatable.Methods: Forty-two patients with positive Candida episodes in CSF were enrolled in this retrospective study.Results: A total of 42.9% (18/42) were determined to have probable Candida meningitis (PCM). Neurosurgery [odds ratio (OR) (95% confidence interval), OR: 14.4 (1.6–126.1), P = 0.004], lumbar drainage [OR: 5.8 (1.5–23.3), P = 0.009], VP shunt [(OR: 5.6 (1.2–25.8), P = 0.020)], external ventricular drainage [OR: 4.7 (1.3–17.7), P = 0.018], CRP ≥ 10.0 mg/L [OR: 4.9 (1.3–18.1), P = 0.034], and postsurgical broad-spectrum antibiotics [OR: 9.5 (1.8–50.5), P = 0.004] were risk factors associated with PCM. A single CSF Candida episode for the diagnosis of PCM had 7.7% (0.4–37.9%) sensitivity and 20.7% (8.7–40.3%) specificity, whereas repeated episodes of Candida had 66.7% (41.2–85.6%) sensitivity and 95.8% (76.9–99.8%) specificity. No significant difference was found in radiological imaging or CSF profiles between PCM and non-PCM patients. A total of 37.5% (9/24) of patients without PCM received empirical antifungal treatment, and 88.9% (16/18) of patients with PCM received preemptive antifungal treatment. PCM patients had hospitalized mortality rates of 50.0% (9/18). The odds ratio of mortality was 23.0 (2.5–208.6) for PCM patients compared with non-PCM patients (P = 0.001).Conclusion: Both single and repeated positive CSF samples have low validity for the diagnosis of PCM, suggesting that novel strategies for diagnosis algorithms of PCM are urgently needed. Empirical antifungal treatment should be started immediately for suspicious patients with risk factors.

scholarly journals Risk Factors and Management Strategies of Cerebrospinal Fluid Leakage Following Lumbar Posterior Surgery

2021 ◽  
Author(s):  
jin tang ◽  
qilin lu ◽  
ying li ◽  
congjun wu ◽  
xugui li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Revision Surgery ◽  
Cerebrospinal Fluid Leakage ◽  
Posterior Surgery ◽  
Fluid Leakage ◽  
Removal Time ◽  
Hormone Injection ◽  
Extubation Time ◽  
Duration Of Disease

Abstract Objective: To analyze the risk factors of cerebrospinal fluid leakage(CSFL) following lumbar posterior surgery and summarize the related management strategies. Methods: A retrospective analysis was performed on 3179 patients with CSFL strategies lumbar posterior surgery in our hospital from January 2019 to December 2020. There were 807 cases of lumbar disc hemiation(LDH), 1143 cases of lumbar spinal stenosi (LSS), 1122 cases of lumbar spondylolisthesis(LS), 93 cases of lumbar degenerative scoliosis(LDS),14 cases of lumbar spinal benign tumor(LST). Data of gender, age, body mass index(BMI), duration of disease, diabete,smoking history, preoperative epidural hormone injection, number of surgical levels, surgical methods (total laminar decompression, fenestration decompression), revision surgery, extubation time, suture removal time, and complications were recorded.Results: The incidence of 115 cases with cerebrospinal fluid leakage,was 3.62% (115/3179).One-way ANOVA showed that gender, body mass index(BMI), smoking history, combined with type 2 diabetes and surgical method had no significant effect on CSFL(P >0.05). Age, type of disease, duration of disease, preoperative epidural hormone injection, number of surgical levels and revision surgery had effects on CSFL(P<0.05). Multivariate Logistic regression analysis showed that type of disease, preoperative epidural hormone injection, number of surgical levels and revision surgery were significantly affected CSFL(P<0.05), and duration of disease and age of the patients were not significantly affected CSFL (P >0.05).The extubation time of CSFL patients ranged from 7 to 11 days, with an average of 7.11±0.48 days, the extubation time of patients without CSFL was 1-3 days, with an average of 2.02±0.13 days, and there was a statistical difference between the two groups(P < 0.05).The removal time of CSFL patients was 12-14 days, with an average of 13.11±2.67 days, and the removal time of patients without CSFL was 10-14 days, with an average of 12.87±2.19 days, there was no statistically significant difference between the two groups (P>0.05). Conclusion: Type of disease, preoperative epidural hormone injection, number of surgical levels and revision surgery were the risk factors for CSFL. Effective prevention were the key to CSFL in lumbar surgery.Once appear, CSFL can also be effectively dealt with without obvious adverse reactions after intraoperative effectively repair dural, head down, adequate drainage after operation, the high position, rehydration treatment, and other treatments.

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