RESUMEN
STUDY DESIGN: A report of three cases of pyogenic osteomyelitis of the occipitocervical junction. OBJECTIVE: To describe the conservative management of pyogenic osteomyelitis of the occipitocervical junction. SUMMARY OF BACKGROUND DATA: The therapeutic approach to inflammation of the upper cervical spine is controversial. METHODS: Pyogenic osteomyelitis of the occipitocervical junction is rare. In the orthopedic literature, only a few case reports with variable treatment methods are available. Three patients with pyogenic osteomyelitis of the occipitocervical junction were treated nonoperatively. Intravenous antibiotic therapy was begun after direct cultures or blood cultures were obtained. Early mobilization was accomplished by application of a halo vest. RESULTS: Two patients recovered by spontaneous fusion of the occipitocervical junction. Instability developed in the spine of one patient, but she refused further treatment. CONCLUSIONS: Diagnosis of osteomyelitis of the upper cervical spine is difficult. In cases with absence of neurologic symptoms or spinal abscess formation, treatment can be nonoperative.
Asunto(s)
Antibacterianos , Vértebras Cervicales , Quimioterapia Combinada/uso terapéutico , Hueso Occipital , Osteomielitis/terapia , Restricción Física/métodos , Enfermedades de la Columna Vertebral/terapia , Adulto , Biopsia , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/patología , Diagnóstico Diferencial , Quimioterapia Combinada/administración & dosificación , Femenino , Estudios de Seguimiento , Humanos , Inyecciones Intravenosas , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Hueso Occipital/diagnóstico por imagen , Hueso Occipital/patología , Osteomielitis/diagnóstico , Enfermedades de la Columna Vertebral/diagnóstico , Supuración/diagnóstico , Supuración/terapia , Tomografía Computarizada por Rayos XRESUMEN
We report diagnostic procedures and conservative therapy of eight patients suffering from unspecific bacterial cervical spondylitis. In three cases an infection of the craniocervical junction occurred. In addition to the clinical examination the diagnosis was made by the help of a serological examination, conventional radiographs, radioisotopes scannings and tomograms (CT and MRI). In all cases therapy was conservative because of absence of neurological symptoms. For immobilization a halo-west was used. Intravenous and oral antibiotics were applied according to antibiogram. In five cases an osseous fusion was achieved, six out of eight patients had no more complaints. The malposition of the concerned segment increased in one case, in a further case a post-arthritic arthrosis evolved.
Asunto(s)
Vértebras Cervicales , Espondilitis/terapia , Adulto , Anciano , Antibacterianos/administración & dosificación , Vértebras Cervicales/patología , Terapia Combinada , Diagnóstico por Imagen , Femenino , Estudios de Seguimiento , Humanos , Inmovilización , Masculino , Persona de Mediana Edad , Espondilitis/diagnóstico , Resultado del TratamientoRESUMEN
Stereotactic cysto-ventricular shunting in three patients with congenital (subependymal cyst of the 3rd ventricle, subependymal cyst of the foramen of Monro, cyst of cavum septi pellucidi) and in a female patient with a large cystic suprasellar craniopharyngeoma is dealt with in this paper. The first operation was performed in May 1992 and the latest, being considered in this paper, in October 1993. All patients were admitted to our hospital suffering from signs of increased intracranial pressure. CT-scans revealed on the one hand an obstructive hydrocephalus subjected to the cystic arachnoid lesions, on the other hand a large hypodense suprasellar cystic tumor. After stereotactic puncture of the arachnoid cysts, aspiration of their contents as well as biopsy of the wall, a silicone catheter was implanted, thus constructing a permanent communication between the cyst and the lateral or third ventricle. The internal catheter was connected to a subcutaneous burr-hole reservoir. All these patients recovered uneventfully without neurological deficits. There were no operative complications. Follow-up CT-scans showed no recurrences of the cysts and obstructive hydrocephalus. In the patient with the suprasellar craniopharyngeoma at first a stereotactic puncture of the cyst was performed. After recurrence the tumor was directly approached by an frontotemporal craniotomy. The histological examination revealed now a craniopharyngeoma. After renewed recurrence a stereotactic cysto-ventriculostomy with internal shunt implantation was performed. However, in this case this method was unsuccessful, documented by follow-up CT-scans. Resulting from our experiences, it is quite obvious that the stereotactic internal shunt implantation seems to be a safe, proper and reliable method in the treatment of arachnoid cystic lesions.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Quistes Aracnoideos/cirugía , Derivaciones del Líquido Cefalorraquídeo/métodos , Craneofaringioma/cirugía , Neoplasias Hipofisarias/cirugía , Adulto , Anciano , Quistes Aracnoideos/diagnóstico , Quistes Aracnoideos/diagnóstico por imagen , Craneofaringioma/diagnóstico , Craneofaringioma/diagnóstico por imagen , Femenino , Humanos , Lactante , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neoplasias Hipofisarias/diagnóstico , Neoplasias Hipofisarias/diagnóstico por imagen , Técnicas Estereotáxicas , Tomografía Computarizada por Rayos X , Insuficiencia del TratamientoRESUMEN
Stereotactic cysto-ventricular shunting in three patients with congenital (subependymal cyst of the 3rd ventricle, subependymal cyst of foramen of Monroi, cyst of cavum septi pellucidi) is dealt with in this paper. The first operation was performed in May 1992 and the latest, being considered in this paper, in January 1993. All patients were admitted to our hospital suffering from increased intracranial pressure. CT-scans revealed an obstructive hydrocephalus subjected to the cystic lesions. After stereotactic puncture of these cysts, aspiration of their contents as well as biopsy of the wall a silicone catheter was implanted, thus constructing a permanent communication between the cyst and the lateral or 3rd ventricle. The internal catheter was connected to a subcutaneous burr-hole reservoir. All patients recovered uneventfully without neurological deficits. There were no operative complications. Follow-up CT-scans showed no recurrences of the cysts and obstructive hydrocephalus. Resulting from our experiences, it is quite obvious that the stereotactic internal shunt implantation seems to be a safe, proper and reliable method in the treatment of such cystic lesions. Open craniotomy or intracorporal shunting procedures and their immanent complications can be avoided for most cases of congenital intracranial cysts. It should, therefore, be the aim of further clinical investigations to prove the value of this method in additional cases.