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PubMed1976

Focal angiographic abnormalities with subdural empyema.

Thirteen patients with subdural empyema underwent arteriography preoperatively and three were restudied postoperatively. Arterial vascular changes were found in nine cases and consisted of localized or diffuse arterial irregularities. In two cases the arterial changes resolved with effective therapy. These arterial changes are similar in appearance and response to therapy to those noted with meningitis; however, in this series they were shown to have occured in seven cases with subdural empyema but without associated meningitis. Therefore, empyema alone may cause localized or diffuse arterial irregularities.

Adolescent↗
PubMed1993

Functional neurosurgery in the treatment of epilepsy in The Netherlands. Aspects of presurgical evaluation and the contribution of subdural and stereotactically implanted depth electrodes in the Dutch Workgroup for Functional Surgery.

In the Netherlands all patients who are considered candidates for surgical treatment of their epilepsy are referred to the Dutch Workgroup for Functional Neurosurgery. Resective neurosurgery in partial epilepsy is a focus of special interest of national health authorities. Annually 15-20 patients can now be operated upon. Presurgical evaluation includes a.o. 18/FDG PET. For depth-EEG recording a specially designed method of "Combined Subdural and Depth-EEG Recording" is used which has been described previously. 70 patients underwent depth-EEG recording with the combined method. In 4.2% of the patients there were transient complications, in 1.4% there was a possibly permanent slight neurological deficit caused by the method. Fifty-six patients were evaluated at least one year after their surgical treatment (median follow-up 3 years). In the frontal lobe group comprising 9 patients 56% were seizure-free, 76% benefited from the treatment. In the temporal lobe group with 47 patients 68% were seizure-free and 92% benefited. No patient deteriorated from the resection. Permanent morbidity was nil.

Brain Mapping↗
PubMed1984

Post-traumatic subdural hygromas: observations concerning a surgical enigma.

Four per cent (38) of 881 head injured patients developed known subdural hygromas. Their times of onset and course were variable. However, only two large hygromas seemed clinically significant. Hygromas were more frequent when intracranial pressure monitors were placed, possibly due to opening of the arachnoid, particularly if intracranial pressure was low. But, of course, monitors were only inserted in more severely injured patients. The use of Richmond bolts to drain subdural hygromas in a controlled fashion while monitoring intracranial pressure is suggested.

Adult↗
PubMed1986

Mixed bacterial subdural empyema complicating subdural peritoneal shunt.

Bilateral subdural empyema occurred in a nine-month-old boy with a subdural-peritoneal shunt. Because of the mixed composition of bacterial growths, representative of faecal flora, it is assumed that the infection originated from perforation of the bowel by the distal tip of the shunt catheter, although no abnormal abdominal signs or symptoms were noted.

Anti-Bacterial Agents↗
PubMed1987

Lumbosacral lipoma causing tethering of the conus: case report.

We report a case of tethered cord syndrome treated surgically. As in many reported cases, the treatment was successful on pain but only partially so on sphincter dysfunction. The most important diagnostic investigation is CT scanning with contrast medium.

Adult↗
PubMed1988

Multiple subdural abscesses following colonic perforation--a rare complication of a ventriculoperitoneal shunt.

A case of colonic perforation by a ventriculoperitoneal shunt, its subsequent migration and protrusion from the anal orifice is reported. The shunt reservoir and ventricular catheter were removed percutaneously, and the disconnected peritoneal catheter was pulled out through the anus. Blood culture grew Klebsiella pneumoniae and Streptococcus fecalis. CT scan showed multiple subdural abscesses with evidence of ventriculitis. Removal of the shunt (as described), evacuation of subdural pus and systemic antibiotics resulted in complete recovery.

Anal Canal↗
PubMed1990

Analgesia and serum concentrations of extradural, subdural and intraperitoneal fentanyl in a rat model.

The effects of epidural, subdural and intraperitoneal fentanyl were determined on the tail flick response of the rat using the response latency as a measure of analgesia. Dose-time-response curves were generated for incremental doses of fentanyl administered at constant injection volumes. Serum concentrations at varying doses were determined using a radioimmunoassay technique. It was found that serum concentrations for extradural, subdural and intraperitoneal fentanyl were similar at the low doses, but differed significantly at higher doses suggesting that pharmacokinetic differences may be concentration dependent. Extradural administration of naloxone (0.004 mg) was able to antagonize extradural fentanyl (8.0 micrograms), a dose eight-fold greater than the lowest maximally effective dose. The relationship between serum fentanyl concentrations and administered doses suggest that the analgesic properties of extradural and subdural fentanyl are in part dependent on centrally mediated actions.

Analgesia↗
PubMed1981

Epidural morphine and post-operative pain relief.

Epidural morphine was compared with placebo in two randomly selected but similar groups of patients undergoing upper abdominal operations. There was no quantitative or qualitative difference in the analgesia obtained in the two groups of patients but there were significantly diminished long term requirements of intramuscular morphine in those who had been previously given epidural morphine when compared with epidural placebo. The possible causes and implications of this difference are discussed.

Humans↗
PubMed1996

Surgical anaesthesia for Caesarean section with a subdural catheter.

PURPOSE: This case report describes a radiologically proven subdural catheter placed in a term parturient, which consistently performed as an epidural catheter for both labour analgesia as well as surgical anaesthesia. CLINICAL FEATURES: The patient was a 26-yr-old, 52.7 kg. 140 cm healthy woman with a 39 wk intrauterine pregnancy. At initiation of epidural blockade, and for many hours throughout labour, an appropriate volume and concentration of local anaesthetic achieved an appropriate analgesic sensory level (10 ml bupivacaine 0.25%, bilateral T10 sensory level). However, for Caesarean section, while an appropriate volume and concentration of local anaesthetic achieved an appropriate surgical anaesthetic sensory level (15 ml bupivacaine 0.5%, bilateral T4 sensory level), there was no demonstrable motor blockade (0 on the Bromage scale). The Caesarean section was performed without incident, and without the need for supplemental intravenous opioids or anxiolytics. CONCLUSION: We report the case to question the commonly held beliefs of subdural catheter presentation. We questioned the catheter position, and proved its subdural placement, only after larger volumes of higher concentration local anaesthetic did not achieve expected goals. It is possible that a high percentage of epidural catheters may be subdural, unbeknownst to the practitioner.

Adult↗
PubMed2000

Complications of subduroperitoneal shunting.

OBJECTS: Subduroperitoneal (SP) shunts have been widely used in the management of pediatric subdural fluid collections. METHODS: We retrospectively reviewed the complications of SP shunting in 73 boys and 24 girls, who ranged in age from 1 to 180 months (median 7 months). Subdural fluid collection was bilateral in 75 and unilateral in 22 patients. The most common complication was shunt obstruction (13 patients). Shunt migration was seen in 8 patients. Migration occurred only with unishunts without a reservoir and with peritoneal catheters. However, the shunts with a reservoir or flushing valve led to skin necrosis in 4 patients (P=0.003). Unilateral drainage though bilateral collections were present, infection, bowel perforation, and ileus occurred in 5, 4, 1 and 1 patients respectively. CONCLUSIONS: These SP shunt complications, some of which are avoidable, should be kept in mind.

Adolescent↗
PubMed2000

Spontaneous intracranial hypotension: use of unenhanced MRI.

We report a case of spontaneous intracranial hypotension diagnosed with unenhanced cranial MRI, showing laminar subdural fluid and engorgement of the hypophysis and perisellar sinuses. Cerebrospinal fluid pressure was low. MRI was normal after resolution of symptoms. Prior reports emphasise the enhancing pachymeninges seen in this syndrome. We maintain that, when subdural collections and perisellar engorgement are detected on unenhanced MRI in the proper clinical setting, contrast enhancement may not be necessary for the diagnosis.

Adult↗