Polymicrobial brain stem abscess due to Streptococcus anginosus and Actinomyces species

This report describes a rare case of a pyogenic brain stem abscess. The lesion was readily identified by computed tomographic (CT) scan and magnetic resonance imaging (MRI). Streptococcus anginosus was grown from the pus and Actinomyces colonies were found on histopathology. The lesion was successfully treated with stereotactic surgery and antibiotic therapy. A review of the relevant literature including the role of stereotaxy in the treatment of the brain stem abscess is discussed.     

立体定向下神经内镜治疗多房性脑脓肿(附14例临床分析)

目的探讨立体定向辅助下神经内镜手术治疗多房性脑脓肿临床可行性。方法对我科2006年11月至2010年10月多房性脑脓肿14例,采用立体定向辅助下神经内镜手术治疗回顾分析。结果均一次穿刺成功,手术后脓腔消失,经随访8个月至3年,13例脓肿壁完全消失,术后1例复发。结论认为立体定向辅助下神经内镜手术治疗多房性脑脓肿具有定位准确、安全、创伤小等优点,此方法操作可行,疗效理想。     

立体定向引导显微手术切除颅内较小占位性病变

目的探讨立体定向技术切除颅内较小占位病变的方法及引导显微手术切除的优越性。方法采用瑞典Leksell-G型立体定向仪及手术计划系统对42例患者49个颅内较小占位病变行术前精确定位后,环钻开颅,在显微镜下切除病灶。结果所有病例均为全切,病变性质脑膜瘤9例(其中2个部位2例),转移瘤8例(其中2个部位2例,3个部位1例),胶质瘤7例,脑脓肿7例,脑囊虫5例,3例结核瘤,2例海绵状血管瘤,1例血管母细胞瘤,无手术并发症及死亡病例。结论立体定向引导显微手术切除颅内较小占位病变是一种定位精确,创伤轻微,安全和有效的手术方法,特别在颅内多发及功能区占位病变切除方面有无可替代的优越性。     

Brain stem abscesses in childhood

Background Solitary brain stem abscess is a rare condition with high mortality and morbidity. These lesions were considered to be invariably fatal before 1974 when advanced diagnostic tools were not available. Recently, the diagnosis and prognosis of brain stem abscesses have been modified by the introduction of modern radiological tools, and several patients with a favorable outcome have been reported since then. Because the pons is the most common site of the abscesses, involvement of the sixth and seventh nerves is frequent. The midbrain is the second most likely location, and medullary abscesses are distinctly rare. Treatment of a brain stem abscess includes medical therapy alone, open microsurgical intervention, or stereotactic aspiration.Case report We report a case of a 7-year-old girl with a solitary brain stem abscess. Her neurological examination revealed involvement of the cranial nerves and pyramidal tracts. Microsurgical exposure and aspiration of the abscess resulted in rapid improvement in her neurological condition and radiological resolution of the lesion. We discuss this uncommon case to draw attention to the importance of early diagnosis and adequate treatment, and we review the relevant literature.     

Successful treatment of brain stem and thalamic abscesses with high-dose meropenem

The incidence of brain abscess remains high, despite the development of novel antibiotics. Vancomycin or carbapenems, which are third-generation cephems, are recommended as standard therapy for bacterial meningitis or brain abscess. The effectiveness of the high-dose meropenem therapy on brain abscess has occasionally been reported. We experienced 2 consecutive cases of brain abscess in adults. The first patient was a 67-year-old man with diplopia, dizziness, and dysesthesia on the left upper and lower extremities. Images of T1-weighted magnetic resonance imaging (MRI) with contrast medium and diffusion-weighted MRI showed a ring enhancing cystic lesion and a high intensity lesion, respectively, in the right pons. The second patient was a 37-year-old man who complained of right hemiparesis. MRI revealed a ring-enhancing cystic mass in the left thalamus. On the basis of MRI findings, patients were diagnosed with brain abscess and were given high-dose meropenem (6g/day) continuously for 2 months. The abscess resolved completely after treatment with meropenem administered intravenously. Further, neurological deficits caused by abscess successfully improved. High-dose meropenem therapy should be considered as an effective treatment for brain abscess, even in the brain stem and basal ganglia, where it is quite difficult to achieve surgical access.     

立体定向术治疗多发性脑脓肿(附11例临床分析)

目的通过对立体定向术治疗多发性脑脓肿的回顾性分析,总结手术经验。方法应用Leksell-G型定向仪,行MRI引导下立体定向穿刺 术中抗生素冲洗术,设计最佳手术入路,行多发脓肿穿刺,术后常规应用抗生素治疗2周。结果11例多发脑脓肿患者,共30个脓肿,均一次穿刺成功,经抽吸冲洗后复查脓腔消失。抗生素治疗2周后,经随访全部病例治愈。结论立体定向术具有定位准确、安全、创伤小等优点,适用于多发性脑脓肿及脓肿部位较深或位于语言、运动中枢等主要功能部位,或由于年老体弱或其他严重疾病不能耐受开颅手术者。     

奴卡氏菌性脑脓肿的临床特点(附1例报告)

目的探讨奴卡氏菌性脑脓肿的临床特点。方法回顾性分析1例奴卡氏菌性脑脓肿患者的临床资料。结果本例患者急性起病,以发现右肩肿块后继发头痛、左侧肢体无力为主要症状。既往有"特发性血小板减少性紫癜"病史,长期口服激素、免疫抑制剂治疗。头颅MRI示右侧脑干及左侧顶叶可见圆形占位;增强后呈环形强化。右肩肿块穿刺脓液培养示奴卡氏菌。结论奴卡氏菌性脑脓肿患者死亡率高,要重视病原学诊断与长期特异性抗感染治疗,必要时需结合手术治疗。     

无框架脑立体定向手术在微创神经外科中的应用价值

目的探讨无框架脑立体定向手术在微创神经外科的应用价值。方法1999年11月至2001年6月进行无框架脑立体定向手术200例,其中颅内动静脉畸形43例,动脉瘤39例,脑膜瘤30例,海绵状血管瘤27例,胶质瘤19例,神经鞘瘤8例,垂体腺瘤5例,血管网织细胞瘤4例,转移癌3例,其他14例;脊髓肿瘤8例。结果病灶和重要解剖结构定位准确,病灶定位误差均在2mm以内,术后神经功能损害10例,占5.0%,无手术死亡。结论无框架脑立体定位手术对脑和脊髓手术,尤其是对切除脑深部病灶很有帮助,可以准确发现病灶,保护正常神经组织,改变了传统神经外科手术模式,是微创神经外科的保障。     

Possible role of adjunctive thalidomide therapy in the resolution of a massive intracranial tuberculous abscess

We present the case of a young child who developed a massive tuberculous abscess of the posterior fossa while being treated for pulmonary tuberculosis. Clinical improvement after surgical excision of the abscess was followed by recurrence of symptoms of acutely raised intracranial pressure on standard antituberculosis and corticosteroid therapy. Magnetic resonance (MR) imaging of the brain showed that a multiloculated abscess had developed anterior to the excision site of the original abscess. The recurring abscess was partly excised and drained but could not be removed completely because of its proximity to the brain stem. Thalidomide, a potent inhibitor of tumour necrosis factor alpha (TNF-alpha), was added to the treatment regimen and resulted in marked clinical improvement with resolution of the abscess within 4 months. The remaining CT lesion had the appearance of a small granuloma. Both the clinical and the radiological response was maintained after 1 year of antituberculosis treatment.     

磁共振辅助X-CT立体定向在深部脑肿瘤活检中的应用

本文报告用MRI辅助CT行脑深部肿瘤定向活检42例,男22例,女20例。年龄在4～67岁之间,幕上38例,幕下4例。利用此技术有以下优点:1.协助手术选择最佳穿刺途径,避免穿刺产生血肿;2.可利用MRI区别肿瘤组织和瘤组织周围水肿带;3.提高穿刺准确性。     

Diagnostic and management of pediatric brain stem abscess, a case-based update

Purpose  

Authors report their experience of a pediatric brain stem abscess with a literature review.     

CT立体定向辅助内窥镜技术治疗颅内病变

目的探讨CT立体定向辅助内窥镜技术的临床应用价值。方法回顾性总结2009年1月至2013年2月间收住院并行CT辅助内窥镜立体定向术的24例病例,颅内病变活检8例、脑肿瘤切除6例、脑囊虫取出4例、囊性颅咽管瘤Ommaya管置入2例、脑内异物取出2例、蛛网膜囊肿造瘘2例。结果本组均顺利达到手术目的,无术后昏迷、偏瘫、感染、颅内出血等严重并发症。结论内窥镜立体定向术将立体定向术的准确定位功能和神经内镜术在直视下操作的优点相结合,扩大了手术范围,提高了手术安全性。     

无框扫描立体定向技术在神经外科手术中的应用体会

目的总结无框扫描立体定向技术在神经外科手术中的使用经验和体会。方法回顾分析46例运用无框扫描立体定向技术进行的开颅手术,均行手术规划和(或)术中导航,胶质瘤切除前先穿刺肿瘤边界,放置标记物。结果无框扫描立体定向技术定位误差1.5～2.5mm,平均误差1.8mm,100%准确直达靶点;肿瘤及动静脉畸形均全切除。结论无框扫描立体定向技术具有精确定位、实时导航和辨认组织的功能,且能有效应对术中脑组织漂移,操作简便,能明显减轻手术创伤,减少并发症,是微创神经外科手术的重要辅助技术。     

Deep brain stimulation in dystonia

Journal of Neurology - Renewed interest in stereotaxy for dystonia followed the introduction of deep brain stimulation (DBS) in Parkinson's disease and essential tremor in the 1990s. DBS...     

微创手术在神经外科中的应用价值研究

目的：探讨微创手术在神经外科中的应用价值。方法：1999年11月至2001年8月本组进行微创手术364例，其中无框架脑立体定向手术177例，微骨孔入路123例，微骨孔入路无框架立体定向手术64例。350例开颅手术中颅内占位病变158例，其中脑膜瘤51例，胶质瘤45例，垂体腺瘤12例（经蝶入路5例），神经鞘瘤10例，颅咽管瘤6例，血管网织细胞瘤5例，转移瘤5例，其它24例；动脉瘤108例，动静脉畸形53例，海绵状血管瘤31例。脊髓手术14例。结果：病灶和重要解剖结构定位准确，病灶定位误差均在2mm以内，术后血肿和神经功能损害分别为1例和22例，占6．0％，无手术死亡。结论：微创手术对脑和脊髓外科，尤其对切除脑深部病灶很有帮助，可以准确发现病灶，保护正常神经组织，改变了传统神经外科手术模式。     

Staged bilateral thalamic electrode implantation utilizing frameless stereotactic guidance.

Deep brain stimulation (DBS) for medically intractable Parkinson's disease (PD) is well established, but carries the inconveniences of frame-based neurosurgery. Previous reports have demonstrated that ventricular shunt placement and some functional procedures can be accurately performed using frameless stereotaxy. We present a report indicating that staged deep brain electrode placement can be accurate and efficacious using a frameless skull-mounted guide.     

Frameless stereotactic brain biopsy procedures using the Stealth Station: indications, accuracy and results

This study presents the results of 57 stereotactic brain biopsies using a frameless neuronavigation system, the Stealth Station. The supratentorial lesions had a mean diameter of 33 mm and a mean distance of 32 mm from the entry point at brain surface. In all cases the stereotactic procedure was planned in the preoperative 3-D magnetic resonance data set. In seven cases additional data for identification of eloquent brain areas was integrated from magnetoencephalography or functional magnetic resonance imaging. During surgery the samples were sent to neuropathological examination and the operation completed after the confirmation of pathological tissue. Using this method, in 56 cases a pathological tissue was obtained and a diagnostic yield of 98% was achieved. In two cases (3.5%) a new neurological deficit remained (hemiparesis and visual field deficit). The mean operation time was 92 minutes including examination of frozen sections. The results of our series demonstrate, that frameless stereotactic systems can also be reliably applied for biopsy of supratentorial lesions larger than 15 mm. Frameless stereotaxy in combination with intraoperative pathological confirmation is a safe and reliable method for stereotactic brain biopsy with a diagnostic yield comparable to frame-based stereotaxy.     

Nocardia brain abscess: features, therapeutic strategies and outcome

BACKGROUND AND PURPOSE: Nocardia species is an aerobic soil-saprophyte bacterium, responsible for rare opportunistic infections, mainly reported in immunocompromised patients. Nocardia brain abscess accounts for 1 to 2% of cerebral abscesses. Prognosis is poor. METHODS: We describe clinical, radiological and bacteriological findings along with therapeutic aspects for five patients and review the literature on Nocardia cerebral abscess. RESULTS: The clinical features of Nocardia brain abscess are insidious and nonspecific, occurring frequently with a medical background of obvious or latent immunodeficiency; fever, if any, is observed subordinate to extracerebral nocardiosis. Computerized tomography scan and conventional magnetic resonance (MR) scan show lesions with a necrotic core and multilobed thick walls enhancing after injection of gadolinium or iodine. Abscesses are mainly located in the brain stem, basal ganglia and cerebral cortex of the frontal, parietal and occipital lobes; cerebellar and spinal locations are uncommon. MR diffusion-weighted imaging with calculation of apparent diffusion coefficient and proton MR spectroscopy can provide additional data for accurate differential diagnosis between abscess and other necrotic lesions, such as tumor and cyst formations. Bacteriological identification has progressed with advances in molecular microbiology: 16S rRNA sequencing, allowing a more rapid routine identification of Nocardia strains from clinical samples. Clinical management of patients with a Nocardia brain abscess relies upon early use of intravenous antibiotics adapted to the strains identified and their susceptibility. Most Nocardia strains display susceptibility to cotrimoxazol, amikacin and linezolid, but develop beta-lactamase activity. CONCLUSIONS: Early pus samples, obtained by biopsy or surgical resection, are needed to establish a certain bacteriological diagnosis and initiate appropriate intravenous antibiotics.     

Chronic abscess of the brain stem

The incidence of solitary brain stem abscess is less than 4% of all posterior fossa abscesses, and probably less than 1% of all intracranial abscesses. Two cases are reported, both presenting as chronic progressive clinical problems and initially diagnosed as gliomas. It is suggested that aspiration is a more suitable treatment than excision, and that in cases secondary to otogenic disease, radical mastoidectomy might have been an adequate method of prophylaxis.     

尿激酶辅助立体定向术治疗高血压脑出血

目的探讨尿激酶辅助立体定向术治疗高血压脑出血的临床应用价值。方法对30例高血压脑出血患者(定向组)采取立体定向血肿次全排空术,术中血肿腔置管,术后残留血肿采取尿激酶溶解。以拔管时间及日常生活能力(ADL)评分作为评价疗效的指标,与同期采取CT定位下钻孔抽吸血肿及尿激酶溶解术(抽吸组)的30例患者进行比较。结果定向组拔管时间明显短于抽吸组,疗效明显好于抽吸组。结论尿激酶辅助立体定向术治疗高血压脑出血具有创伤小、操作简便、清除血肿较彻底等优点,是治疗高血压脑出血的一种有效方法。