A rare complication of hardware failure in neurostimulation

2000 ◽  
Vol 93 (2) ◽  
pp. 330-331
Author(s):  
Amr Mohamed Sarwat ◽  
Kota Sadashiv Karanth ◽  
John Christopher Sutcliffe
Keyword(s):  
Skin Rash ◽  
Rare Complication ◽  
Electrical Insulation ◽  
Content Type ◽  
Hardware Failure ◽  
Fine Print

✓ The authors report on a rare complication of neurostimulation. Two patients presented with a skin rash after undergoing neurostimulator implantation, and the implants were found to have faulty electrical insulation. The rash was centered over the source of current leak and disappeared when the problem was corrected.

Recurrent atlantoaxial rotatory fixation in children: a rare complication of a rare condition

2004 ◽  
Vol 100 (3) ◽  
pp. 307-311 ◽  
Author(s):  
John E. Crossman ◽  
Dominic Thompson ◽  
Richard D. Hayward ◽  
Andrew O. Ransford ◽  
H. Alan Crockard
Keyword(s):  
Rare Complication ◽  
Spinous Process ◽  
Operative Procedure ◽  
Rare Condition ◽  
Content Type ◽  
Joint Stabilization ◽  
Atlantoaxial Rotatory Fixation ◽  
Uncommon Condition ◽  
Rotatory Fixation ◽  
Fine Print

✓ Atlantoaxial rotatory fixation (AARF) is an uncommon condition of childhood. Occasionally AARF may recur. The authors describe the cases of four patients with recurrent AARF (RAARF). The probable cause of the RAARF and operative procedure selected are discussed. In three cases, attempts were made to stabilize the atlantoaxial complex rather than to perform fusion to preserve the function of the joint complex. Joint stabilization is performed by incorporating a “check ligament” into the joint construct between the axial spinous process and the atlantal lateral mass. The authors believe this technique of joint stabilization augments the strength of the joint, allowing normal, but preventing excessive, rotation, until the joint reaches physiological maturity.

Use of structural allografts in spinal osteomyelitis: a review of 47 cases

2000 ◽  
Vol 93 (1) ◽  
pp. 8-14 ◽  
Author(s):  
James M. Schuster ◽  
Anthony M. Avellino ◽  
Frederick A. Mann ◽  
Allain A. Girouard ◽  
M. Sean Grady ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Persistent Infection ◽  
Perceived Risk ◽  
Recurrent Infection ◽  
Content Type ◽  
Hardware Failure ◽  
Spinal Osteomyelitis ◽  
Structural Allografts ◽  
Fine Print

Object. The use of structural allografts in spinal osteomyelitis remains controversial because of the perceived risk of persistent infection related to a devitalized graft and spinal hardware. The authors have identified 47 patients over the last 3.5 years who underwent a surgical decompression and stabilization procedure in which fresh-frozen allografts were used after aggressive removal of infected and devitalized tissue. The patients subsequently underwent 6 weeks of postoperative antibiotic therapy (12 months for those with tuberculosis [TB]). Methods. Follow-up data included results of serial clinical examinations, radiography, laboratory analysis (erythrocyte sedimentation rate and white blood cell count), and clinical outcome questionnaires. Of the original 47 patients (14 women and 33 men, aged 14–83 years), 39 were available for follow up. The average follow-up period at the time this article was submitted was 17 ± 9 months (median 14 months, range 6–45 months). In the majority of cases (57%), a Staphylococcus species was the infectious organism. Predisposing risk factors included intravenous drug abuse (IVDA), previous surgery, diabetes, TB, and concurrent infections. During the follow-up period only two patients suffered recurrent infection at a contiguous level; both had a history of IVDA and one also had a chronic excoriating skin condition. No other recurrent infections have been identified, and no patient has required reoperation for persistent infection or allograft/hardware failure. Conclusions. It is the authors' opinion that the use of structural allografts in combination with aggressive tissue debridement and adjuvant antibiotic therapy provide a safe and effective therapy in cases of spinal osteomyelitis requiring surgery.

Extradural hematoma during craniotomy

1974 ◽  
Vol 40 (6) ◽  
pp. 783-785 ◽  
Author(s):  
Henry Troupp
Keyword(s):  
Rare Complication ◽  
Extradural Hematoma ◽  
Content Type ◽  
Surgical Exposure ◽  
Obvious Reason ◽  
The Brain ◽  
Fine Print

✓ The author describes five instances of extradural hematoma that developed during craniotomy. The hematomas extended basally from an original craniotomy near the midline and four required immediate additional surgical exposure. This rare complication should be remembered during craniotomy if the brain appears to be swelling without obvious reason.

Cerebrospinal fluid edema: a rare complication of shunt operations for hydrocephalus

1982 ◽  
Vol 57 (5) ◽  
pp. 697-700 ◽  
Author(s):  
Yasuhiro Chiba ◽  
Hiroshi Takagi ◽  
Fumoto Nakajima ◽  
Satoshi Fujii ◽  
Takao Kitahara ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
White Matter ◽  
Rare Complication ◽  
Shunt Revision ◽  
Ventricular Catheter ◽  
Shunt Operation ◽  
Low Density ◽  
Content Type ◽  
Low Density Area ◽  
Fine Print

✓ Three cases are presented in which a rare complication occurred after a shunt operation for hydrocephalus. On postoperative computerized tomography (CT) scans, extensive low-density areas appeared in the white matter along the ventricular catheter. After shunt revision, gradual resolution or disappearance of the low-density area was clearly demonstrated on CT. In one patient, a collection of cerebrospinal fluid (CSF) was confirmed at operation and appeared to lie in the extracellular spaces of the white matter. The phenomenon is considered to be localized CSF edema, different from porencephaly.

Complications of chronic vagus nerve stimulation for epilepsy in children

2003 ◽  
Vol 99 (3) ◽  
pp. 500-503 ◽  
Author(s):  
Matthew D. Smyth ◽  
R. Shane Tubbs ◽  
E. Martina Bebin ◽  
Paul A. Grabb ◽  
Jeffrey P. Blount
Keyword(s):  
Vagus Nerve ◽  
Nerve Stimulation ◽  
Surgical Complications ◽  
Vagus Nerve Stimulation ◽  
Deep Infection ◽  
Shoulder Abduction ◽  
Device Removal ◽  
Content Type ◽  
Hardware Failure ◽  
Fine Print

Object. The aim of this study was to define better the incidence of surgical complications and untoward side effects of chronic vagus nerve stimulation (VNS) in a population of children with medically refractory epilepsy. Methods. The authors retrospectively reviewed the cases of 74 consecutive patients (41 male and 33 female) 18 years of age or younger (mean age 8.8 years, range 11 months–18 years) who had undergone implantation of a vagal stimulator between 1998 and 2001 with a minimum follow up of 1 year (mean 2.2 years). Of the 74 patients treated, seven (9.4%) had a complication ultimately resulting in removal of the stimulator. The rate of deep infections necessitating device removal was 3.5% (three of 74 patients who had undergone 85 implantation and/or revision procedures). An additional three superficial infections occurred in patients in whom the stimulators were not removed: one was treated with superficial operative debridement and antibiotic agents and the other two with oral antibiotics only. Another four stimulators (5.4%) were removed because of the absence of clinical benefit and device intolerance. Two devices were revised because of lead fracture (2.7%). Among the cohort, 11 battery changes have been performed thus far, although none less than 33 months after initial implantation. Several patients experienced stimulation-induced symptoms (hoarseness, cough, drooling, outbursts of laughter, shoulder abduction, dysphagia, or urinary retention) that did not require device removal. Ipsilateral vocal cord paralysis was identified in one patient. One patient died of aspiration pneumonia more than 30 days after device implantation. Conclusions. Vagus nerve stimulation remains a viable option for improving seizure control in difficult to treat pediatric patients with epilepsy. Surgical complications such as hardware failure (2.7%) or deep infection (3.5%) occurred, resulting in device removal or revision. Occasional stimulation-induced symptoms such as hoarseness, dysphagia, or torticollis may be expected (5.4%).

Occipitocervical reconstruction with the Ohio Medical Instruments Loop: results of a multicenter evaluation in 30 cases

2003 ◽  
Vol 98 (3) ◽  
pp. 239-246 ◽  
Author(s):  
Sheila K. Singh ◽  
Lynda Rickards ◽  
Ronald I. Apfelbaum ◽  
R. John Hurlbert ◽  
Dennis Maiman ◽  
...  
Keyword(s):  
Spinal Injury ◽  
High Rate ◽  
Os Odontoideum ◽  
Rigid Fixation ◽  
Content Type ◽  
Hardware Failure ◽  
Wide Range ◽  
Medical Instruments ◽  
Fine Print

Object. Stabilization of the craniocervical junction (CCJ) remains a significant challenge. In this multicenter study, the authors present the results of an evaluation of a precontoured titanium implant, the Ohio Medical Instruments (OMI) Loop, for craniocervical fixation. Methods. In this multicenter retrospective study the authors evaluated 30 patients (16 female, 14 male; mean age 53.8 years) with rheumatoid arthritis (15 cases), traumatic occipitoatlantoaxial instability (six cases), congenital vertebral anomalies (two cases), instability due to basilar invagination in the setting of Chiari malformation (two cases), or Down syndrome (one case), tumor (one case), os odontoideum (two cases), and pseudarthrosis/other (one case), who underwent OMI Loop—assisted occipitocervical reconstruction. The mean follow-up period was 25.4 months (range 6–60 months). A solid reconstruction was achieved in 29 of 30 cases; there was only one case of hardware failure requiring reoperation. Noncritical hardware failure occurred in two patients in whom partial occipital screw backout occurred but did not necessitate reoperation. There were no perioperative neurological complications. One patient (3.3%) experienced a delayed postoperative worsening of myelopathy at 1 year that resolved with further surgery. Postoperatively, in 66.6% of patients the degree of myelopathy remained stable (as measured by American Spinal Injury Association [ASIA] scores), whereas 30% improved by one or more ASIA grade. The rate of osseous fusion was 96.6% at a mean follow-up period of 25.4 months. Conclusions. The authors found that the OMI Loop is a versatile precontoured occipitocervical fixation device that can be applied to a wide range of CCJ lesions. It provides excellent immediate rigid fixation of the CCJ, a high rate of osseous fusion, and a low rate of hardware failure.

Death after late failure of third ventriculostomy in children

2002 ◽  
Vol 97 (1) ◽  
pp. 211-215 ◽  
Author(s):  
Walter J. Hader ◽  
James Drake ◽  
Douglas Cochrane ◽  
Owen Sparrow ◽  
Edward S. Johnson ◽  
...  
Keyword(s):  
Rare Complication ◽  
Obstructive Hydrocephalus ◽  
Vegetative State ◽  
Neurofibromatosis Type ◽  
Third Ventriculostomy ◽  
Content Type ◽  
Vp Shunt ◽  
Late Failure ◽  
Increased Icp ◽  
Fine Print

✓ Late failure following successful third ventriculostomy for obstructive hydrocephalus is rare, and death caused by failure of a previously successful third ventriculostomy has been reported only once. The authors present three patients who died as a result of increased intracranial pressure (ICP) after late failure of a third ventriculostomy. Through a collaborative effort, three patients were identified who had died following third ventriculostomy at one of the authors' institutions. A 13-year-old girl with neurofibromatosis Type 1 underwent third ventriculostomy for obstructive hydrocephalus caused by a tectal lesion. Three years later her condition deteriorated rapidly over the course of 6 hours and she was found dead at home. A 4-year-old boy treated with third ventriculostomy for aqueductal stenosis presented 2 years postoperatively with symptoms of increased ICP. This patient suffered a cardiorespiratory arrest while under observation and died despite external ventricular drainage. A 10-year-old boy with previous ventriculoperitoneal (VP) shunt placement underwent conversion to a third ventriculostomy and shunt removal. Eight months after the procedure his condition deteriorated, with evidence of raised ICP, and he underwent emergency insertion of another VP shunt, but remained in a vegetative state and died of complications. Neuropathological examinations in two cases demonstrated that the third ventriculostomy was not patent, and there was also evidence of increased ICP. Late failure of third ventriculostomy resulting in death is a rare complication. Delay in recognition of recurrent ICP symptoms and a false feeling of security on the part of family and caregivers because of the absence of a shunt and the belief that the hydrocephalus has been cured may contribute to fatal complications after third ventriculostomy. Patients with third ventriculostomies should be followed in a manner similar to patients with cerebrospinal fluid shunts.

Growing fracture of the skull and the role of computerized tomography

1981 ◽  
Vol 55 (3) ◽  
pp. 470-472 ◽  
Author(s):  
Richard H. Lye ◽  
J. V. Occleshaw ◽  
John Dutton
Keyword(s):  
Head Injury ◽  
Computerized Tomography ◽  
Case History ◽  
Rare Complication ◽  
Leptomeningeal Cyst ◽  
Content Type ◽  
History Of ◽  
Fine Print

✓ Growing fracture of the skull is a rare complication following head injury. The case history of a child with such a fracture, who developed a leptomeningeal cyst, is presented. The unusual features of this case are discussed in the light of previous reports. The usefulness of computerized tomography in obviating the need for more invasive preoperative investigations is demonstrated.

Osteosarcoma and fibrosarcoma caused by postoperative radiotherapy for a pituitary adenoma

2002 ◽  
Vol 96 (5) ◽  
pp. 960-963 ◽  
Author(s):  
Kanna K. Gnanalingham ◽  
Aabir Chakraborty ◽  
Malcolm Galloway ◽  
Tamas Revesz ◽  
Michael Powell
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Rare Complication ◽  
Postoperative Radiotherapy ◽  
Pituitary Macroadenoma ◽  
Content Type ◽  
Sarcomatous Change ◽  
First Case ◽  
Fine Print

✓ Sarcomatous change is a rare complication of postoperative radiotherapy for pituitary adenomas. The authors report on what they believe to be the first case in which fibrosarcoma and, later, osteosarcoma developed during a 14-year period following surgery and radiotherapy for a nonsecreting pituitary macroadenoma.

Hydroxyapatite laminar spacers and titanium miniplates in cervical laminoplasty

2002 ◽  
Vol 97 (3) ◽  
pp. 323-329 ◽  
Author(s):  
Takeo Goto ◽  
Kenji Ohata ◽  
Toshihiro Takami ◽  
Misao Nishikawa ◽  
Naohiro Tsuyuguchi ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spinous Process ◽  
Spinal Tumors ◽  
Cervical Laminoplasty ◽  
En Bloc ◽  
Content Type ◽  
Hardware Failure ◽  
Fine Print ◽  
Posterior Elements

Object. The authors describe a new surgical technique for cervical laminoplasty that was performed in 25 patients. The posterior elements along with the various ligaments are removed en bloc and are stabilized in a lift-up position by placing hydroxyapatite (HA) laminar spacers and titanium miniplates and screws. The procedure and clinical results are discussed. Methods. The posterior spinal elements, including the lamina(e), spinous process(es), and various attached ligaments, are removed en bloc by incising the lamina in its lateral aspect. Trapezoid-shaped HA spacers are placed between the cut ends of the laminae or between the laminae and lateral masses bilaterally at each level. Malleable titanium miniplates and screws are used for fixation of the spacers. The fixation of transected laminae was judged to be successful. Postoperative care included application of a soft neck collar for 1 week but no further restriction of activity. Surgery-related outcome was assessed in the 21 patients who attended more than 6 months of follow up after laminoplasty. There were 18 men and three women who ranged in age from 27 to 81 years. Cervical stenotic myelopathy was demonstrated in 15 patients who underwent decompressive and expansive laminoplasty, and spinal tumors were documented in six patients who underwent a nonexpansive laminoplasty. Postoperative and follow-up computerized tomography scans demonstrated no hardware failure. Bone formation around the spacers was observed either at 6- or at 9-month follow-up examination in all 21 patients. Fusion of the reconstructed laminae was found to be completed at 12 months in all 18 patients able to attend follow up for this duration. Spinal alignment and the range of motion of the cervical spine were well preserved. In patients with stenotic cervical myelopathy, neurological and anatomical outcome of canal expansion were satisfactory. Conclusions. This technique enables rigid laminoplasty while maintaining anatomical and biomechanical integrity of posterior elements of cervical spine. Expansive and nonexpansive laminoplasty procedures are possible.

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