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Background: Duraplasty refers to the neurosurgical process of reconstructing dural defect. Variety of materials is used for such reconstruction, including natural, semisynthetic, and synthetic materials. Although synthetic materials are readily available and easy to apply, these are associated with foreign body reaction which may lead to serious consequences in some cases. We describe one such rare instance of extradural abscess after polypropylene synthetic fabric duraplasty. Case Description: Our patient is a 33-year-old lady who suffered road traffic accident leading to massive brain laceration, contusion of bilateral frontal lobes, and anterior skull base fractures. Emergency craniotomy was carried out and dural defect repaired with polypropylene (G-Patch; G. Surgiwear® Ltd.) synthetic fabric as the duraplasty material. Three months later, the patient presented with discharging wound at the incision site. Neuroimaging showed ring enhancing lesion in frontobasal extradural space with cutaneous extension. The lesion failed to heal despite intravenous antibiotics and surgery was planned. Intraoperatively, abscess was found between G-Patch and dura. Histopathology showed granulomatous foreign body reaction. The lesion healed after synthetic dura removal and abscess drainage. Conclusion: Although various materials are used for duraplasty, there is no clear consensus on what material should be used for dural repair. Synthetic materials are bio-inert, offer good handling and malleability. Polypropylene has been used safely for both single- and double-layered duraplasty. However, foreign body reaction may occur and very rarely present as extradural abscess. Randomized trials should be done to establish the safety and efficacy profile of commonly used duraplasty materials.

Here we present a case of variceal hemorrhage induced by methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia with epidural abscess in alcoholic cirrhosis. A 65-year-old man with a prior diagnosis of alcoholic cirrhosis, type 2 diabetes mellitus, and hypertension presented with hematemesis to the community hospital He was referred to our hospital for further examination and treatment because sources of bleeding were not identified, despite the existence of esophageal varices during the endoscopic examination at the community hospital. Laboratory examination revealed hemoglobin of 10g/dl, total leukocyte count of 8000 with 76% of neutrophils, platelet count of 470,000/μ1, and prothrombin time of 64%. An emergency endoscopy in our hospital revealed esophagogastric varices (LmF2CbRC2-Lg-cfF2RC0) without active hemorrhage. EIS was performed with 5% ethanolamine oleate to treat esophageal varices on days 2 and 14 of his hospital stay. Follow-up esophagogastroduodenoscopy after EIS demonstrated improvement of esophageal varices graded as LiCwF1RC0. He was admitted with a temperature of 40.0℃ and a complaint of severe back pain. He was identified as being positive for MSSA, and severe back pain remained unchanged. Magnetic resonance imaging revealed a spinal epidural abscess and pyogenic spondylodiscitis at L3-L4 on day 9 of his hospital stay. He was intravenously administered antibiotics for 5 weeks during admission. His temperature returned to normal, and blood tests for markers, such as white blood count and C-reactive protein level, were completely normalized on the day 16 of his stay. He was discharged on oral antibiotics on the day 36 in good condition.

Cholesteatoma is life-threatening disease due to its extracranial and intracranial complications. Extradural abscess is one of them and linked to pus and granulation tissue accumulation between the dura mater and temporal bone. The otogenic extracranial and intracranial complications are rare manifestations in modern era of antibiotics, that’s why we present a 44 old man with successfully treated extradural abscess in retrosigmoid region as a consequence of probably secondary infected through erosion of the external auditory canal extended congenital cholesteatoma.

We report a case of 14-year-old female who was admitted with a rare retroorbital subperiosteal hematoma manifested as sudden orbital pain, progressive proptosis and diminution of vision. Cranial computed tomography showed a biconvex high density mass in the superolateral part of the right orbit, which was recognized to be a subperiosteal hematoma intraoperatively. Infection extending into the orbit was important in causing the hemorrhage.

O abscesso extradural da coluna vertebral tem sido considerado raro. Sua incidência é de 0,2 a 2 casos por 10.000 internações/ano. O presente trabalho apresenta uma revisão sobre abscesso extradural da coluna vertebral, analisando causas, quadro clínico, exames de neuroimagens, tratamento e prognóstico. Trata-se de artigo de revisão baseado em levantamento nas bases de dados Medline/PubMed e SciELO, em que foram analisados os artigos mais relevantes a respeito desse assunto. Foram selecionados 66 artigos, nos quais são analisados fatores predisponentes, localização anatômica, quadro clínico, exames complementares, tratamento e prognóstico. Acomete mais indivíduos idosos e do sexo masculino. Os principais fatores predisponentes são: diabetes mellitus, pacientes imunodeprimidos e intervenções cirúrgicas na coluna vertebral. As condições clínicas pré-operatórias, intervenção cirúrgica precoce, antibioticoterapia apropriada e reabilitação intensiva são fatores determinantes no prognóstico em abscesso extradural da coluna vertebral._________________________________________________________________________________________ ABSTRACT: Extradural abscess in spine is considered rare. Its incidence is 0.2 to 2 cases in 10.000 hospitalization/ year. The present research presents a review about extradural abscess in spine, analyzing causes, clinical state, neuroimaging exams, treatment and prognosis. It’s a review article based in Medline/PubMed and SciELO data, were analyzed the most relevant articles about the present subject. It was analyzed 66 articles, analyzing predisposing factors, anatomical location, clinical state, complementary exams, treatment and diagnosis. Affects mainly the elderly and males. The main predisposing factors are: diabetes mellitus, immunodepressed patients and surgical intervention in spine. Clinical pre-operative conditions, precocious surgical intervention, appropriate antibiotic therapy and intensive rehabilitation are determinant in prognosis of spine extradural abscess.

Intracranial infections caused by Salmonella are rare. We describe the first case of a child undergoing craniofacial surgery for trigonocephaly and subsequently developing an extradural abscess secondary to likely community-acquired Salmonella enteritidis. He underwent surgical washout but returned to theater for a further 2, alongside a prolonged course of intravenous ciprofloxacin. We observed extensive anterior skull bone loss at 78 days postoperatively. At 1 year 11 months, extensive anterior skull bone remodeling had taken place, and the child is currently well.

Tuberculosis of the orbit is rare, even in places where tuberculosis is endemic. The disease may involve soft tissue, the lacrimal gland, or the periosteum or bones of the orbital wall. Intracranial extension, in the form of extradural abscess, and infratemporal fossa extension has been described. This pictorial essay illustrates the imaging findings of nine histopathologically confirmed cases of orbital tuberculosis. All these patients responded to antituberculous treatment.

Although the incidence of otogenic intracranial complications is decreasing, these complications are still serious problems in the otological field. We experienced a case of otogenic intracranial complications due to a giant cholesteatoma in a 77-year-old female. When she was transported to our hospital, she was unconscious. Examination by CT and MRI showed extradural abscess, brain edema and the destruction of the temporal bone. The anatomy of the ossicles and mastoid antrum was not detected. Abscess drainage by a retroauricular incision and the removal of the cholesteatoma were performed immediately. The day after surgery, the patient regained consciousness. The reason she had not complained of severe symptoms before she fell into a coma was not clearly explained. Since the cholesteatoma progressed slowly, central compensation might have been obtained. The present case suggests that immediate treatment is necessary for intracranial complications with advanced cholesteatoma, even if the symptoms are not specific and severe.

OBJECTIVES This study aims to investigate the frequency and management of complications of chronic suppurative otitis media (CSOM). PATIENTS AND METHODS Out of 376 patients with CSOM, 44 patients (25 males, 19 females; mean age 48.5±3.5 years; range 21 to 76 years) meeting study criteria were enrolled in this descriptive cross sectional study which was conducted at the Department of Ear Nose and Throat, Head and Neck Surgery, Postgraduate Medical Institute, Lady Reading Hospital Peshawar. All newly diagnosed patients having CSOM with complications were enrolled. The complications were treated first. Intracranial abscesses were evacuated by neurosurgeons. Radical and modified radical mastoidectomy were performed. RESULTS Majority of the patients presented in the second and third decade of life (21-30 years: 27.27%, 31-40 years: 18.18%). Most of the patients (59.1%) had lower socioeconomic status. Canal wall down mastoidectomy was the most common (79.5%) procedure performed. Cholesteatoma was the most common operative finding (100%). Among extracranial complications, subperiosteal abscess was the most common finding (38.63%), while extradural abscess outnumbered (22.72%) in intracranial complications. CONCLUSION Complications of CSOM commonly affect younger people with low socioeconomic status. Collaborating with neurosurgeons may assist in the successful management of this infection.

Giant intradiploic epidermoid cyst of the skull is a rare tumour. Only a small number of cases have been reported. Over a 16-year period, we treated eight cases of giant intradiploic epidermoid cyst of the skull. All cases were between 19 and 45 years of age, except one aged of 61 years. Five cases presented with local swellings, three patients came with infection and one had an extradural abscess. All the patients were operated upon after adequate preoperative care. Patients with infection required appropriate antibiotics. Total or near total excision was carried out in all. One patient developed postoperative infection. So for those have been no recurrences. This appears to be the largest series of giant intradiploic epidermoid cyst of the skull so far reported.

✓ The year 1993 marked the centennial of the publication of Sir William Macewen's monograph, Pyogenic Infective Diseases of the Brain and Spinal Cord, and its accompanying volume, Atlas of Head Sections. As Harvey Cushing noted, the text on pyogenic diseases of the brain was a landmark in surgery of the nervous system. At the time of its publication, Macewen's work was the most comprehensive study of pyogenic brain diseases. In this paper the author reviews the state of knowledge of brain abscess existing in the 19th and 20th centuries, with particular emphasis on the late 19th century, and elucidates factors contributing to Macewen's remarkable success. His thorough knowledge of the natural history of pyogenic diseases of the temporal bone and nasal sinuses, in addition to his clear description of cranial anatomy, as illustrated in his Atlas of Head Sections, were especially important in developing his successful treatment of brain abscess. The x-ray had not yet been discovered; Macewen's diagnosis was based on clinical findings superbly illustrated by his three clinical stages of brain abscess development. His clinical observations are as relevant today as when he described them 100 years ago. Macewen recorded 25 cases of brain abscess. Nineteen of these patients came to his attention in time to undergo surgery, resulting in 18 recoveries. All five of his patients with extradural abscess recovered. These results were achieved in the era known as “the most glorious period in British surgery.” Neurosurgery was in its infancy; nevertheless, even as the 20th century closes, Macewen's results still have not been surpassed.

A 30-year-old man was admitted to the Shiga Univ. of Medical Science for pyrexia, right otorrhea and right lateral neck swelling. He had not consulted a doctor despite his right otorrhea of 1 year's duration. He was diagnosed as having on extradural abscess and Bezold's abscess caused by chronic otitis media. He was treated with a mastoidectomy, trepanation and antibiotic therapy. Post operatively, he was asymptomatic.

Background Tuberculosis (TB) of the cervical spine occurs rarely in younger children whereas the presentation and outcome are different from those of adult cervical spine. Because cervical spinal TB in younger children is rarely reported, the clinical characteristics, the treatments, and the expected outcome of treatments in younger children are still unknown. Methods We present a case of cervical spine TB in a 24-month-old boy that grounds severe vertebral destruction and an extradural abscess. This child presented with neurological deficit in the form of quadraparesis. We performed anterior cervical debridement for this patient; to our best knowledge, the child in this case is the youngest patient reported in the literature as having had cervical TB treated through anterior cervical surgery. Results The neurological deficits of this patient were recovered soon, and no evidence of recurrence of the tuberculous lesion or of the deformity was revealed by the 6-year follow-up magnetic resonance imaging. Conclusions Based on our experiences in this case and a review of the literature, we propose that for patients of cervical spine TB in early childhood, anterior excision of diseased bone without grafting should be adequate as a surgical measure.

Ten patients underwent reconstruction of skull base defects between 1989 and 1992. In this series, the maximum size of the skull base defect was 6 × 5 cm. Three patients underwent bone grafts to reinforce the skull base. The postoperative course of seven patients without bone grafts was uneventful. There was no cerebrospinal fluid leakage, meningitis, extradural abscess, on brain herniation. On the other hand, two of the three patients with bone grafts developed extradural abseesses requiring the bone grafts to be removed. Although the number of patients in this series is not large, this study demonstrates that the use of bone grafts in reconstruction of skull base detects could be one of the factors in increasing the chances of infectious complications. We think that a bone graft is not necessary to reconstruct moderate-sized skull base defects.

The oldest existing case histories of craniotomy are from the false Hippocratic writings, about 330 BC, and one is reconstructed about the death of Ptolemy VI in 145 BC. Greek surgeons had rational indications for trepanning, when the difficulties of the times are understood. All compound fractures were infected, so death from an extradural abscess was likely. Trepanning was intended to drain the extra dural space.

Case: Few cases of spinal epidural abscess involving an extradural abscess with an intradural extension have been reported. A unique complication with extension of pus from the epidural space through multiple perforations into the dura is described. Due to a proximal meningeal inflammatory reaction, which served as a proximal plug, no cerebrospinal fluid leak was encountered. Conclusion: Intradural extension of pus through multiple dural perforations is a rare complication of spinal epidural abscess and a treatment challenge. Early diagnosis enabling prompt surgical decompression, along with subsequent aggressive debridements and prolonged intravenous antibiotic treatment, can lead to a favorable outcome.

Extradural abscess is a rare but serious complication of the extradural route of administration of analgesic drugs. We report a case of spontaneous extradural abscess diagnosed during placement of an extradural catheter for analgesia after a negative diagnostic laparotomy. Magnetic resonance imaging is the usual diagnostic tool of choice. This, and subsequent surgery, confirmed the diagnosis suspected after drainage of pus through the Tuohy needle.

Patients with orbital cellulitis present to emergency departments occasionally. Symptoms usually develop rapidly, with patients being distressed by painful ocular movements and systemic upset. The case of a 24-year-old man who had a 1-month gradual history of intermittent periorbital swelling after a flu-like illness, and subsequently developed a large intracranial extradural abscess eroding through the temporal bone, ultimately requiring neurosurgical intervention is presented. Although orbital and periorbital swelling is common after acute sinusitis, cellulitis and intracranial abscess are rare but potentially life threatening and sight threatening. Accurate diagnosis is therefore of great importance. In this case, the patient presented with few clinical signs but relevant pathology. The importance of assessing ocular movement, which is a major clinical abnormality indicating orbital disorder and thus an aid to accurate diagnosis, should be highlighted.

We describe an obstetric patient who developed incapacitating headache after inadvertent dural tap and was treated with repeated blood patching. She subsequently developed severe lumbar back pain which, after exclusion of suspected extradural abscess, was treated successfully with simple analgesics and physiotherapy. Two possible explanations are offered to account for her symptoms. We compare this case with others in the literature.

Apesar de sua significativa diminuição após o advento dos antibióticos, as complicações intracranianas das otites médias ainda representam uma situação de risco, uma vez que a taxa de mortalidade permanece alta, chegando a 36%. Entre as formas mais comuns estão meningite, abscesso cerebral, abscesso extradural e tromboflebite do seio lateral. Um alto índice de suspeição é fundamental para seu diagnóstico e manejo precoces. É importante a identificação de casos atípicos que podem estar mascarados pelo uso de antimicrobianos. OBJETIVO: Apresentamos seis casos de complicações intracranianas por otite média em crianças e adolescentes ocorridos no período de dois anos no Serviço de Otorrinolaringologia do Complexo Hospitalar Santa Casa (CHSC). FORMA DE ESTUDO: relato de série. In spite of significant decrease after antibiotic advent, intracranial complications of otitis media still represent a challenging situation owing to its high mortality rate (36%). The most common presentations are meningitis, cerebral abscess, extradural abscess and lateral sinus thrombophlebitis. For early management, it is necessary to have a high index of suspicion. It is important to identify non-typical cases because they might be masqueraded by antibiotic use. AIM: We present six cases of intracranial complications due to otitis media in children and adolescents at Complexo Hospitalar Santa Casa de Porto Alegre for the past two years. STUDY DESIGN: series review.

We present a case of a laryngectomized patient who underwent re-puncture of tracheo-oesophageal fistula for speaking valve voice restoration, resulting in a previously unreported inherent complication of this procedure: extradural abscess of the cervical spine with transient quadriplegia.

SUMMARY We describe a patient who developed an immobilizing lumbovertebral syndrome after an extradural blood patch and who was hospitalized with a. suspected extradural abscess. An infectious aetiology of the persistent backache could be excluded and the patient recovered with analgesics and physiotherapy. The probable aetiology is discussed.

Nasal septal abscess (NSA) is an uncommon sequel to minor nasal trauma. Abscess extension beyond the nasal cavity is rarely documented. A case of a 10-year-old boy who presented with a NSA associated with a large extradural frontal abscess is presented and indications for CT scanning in the workup of pediatric patients with NSA is discussed.

A case of rarely encountered Salmonella typhi osteomyelitis of left occipital bone leading to extradural abscess, is reported. The causative organism was not suspected until the culture report was obtained. The patient responded promptly to surgical drainage and antibiotic therapy.

A case of rarely encountered Salmonella typhi osteomyelitis of left occipital bone leading to extradural abscess, is reported. The causative organism was not suspected until the culture report was obtained. The patient responded promptly to surgical drainage and antibiotic therapy.

Extradural abscess has been described infrequently as a complication of extradural anaesthesia and analgesia. We describe an abscess that developed 5 days after operation in a patient who had extradural anaesthesia for Caesarean section and postoperative analgesia, and review the literature on extradural abscess complicating extradural catheterization, including a discussion on patho-genesis, clinical presentation, diagnosis and management. There have now been 16 reported cases of extradural catheter-related extradural abscess. Only one previous case has been in obstetric practice, despite the widespread use of these techniques in this specialty. A disproportionate number of cases have involved thoracic catheters. Duration of catheterization ranged from 40 h to 6 weeks, the majority of catheters being in place for 5 days or less. The time from catheter placement to development of symptoms ranged from 72 h to 5 months. The causative organism was isolated in 11 cases: Staphylococcus aureus was identified in nine (82%) and Staphylococcus epidermidis in two (18%). Outcome was reported in 15 cases, of which seven (47%) had a full or near full recovery and eight (53%) had a persistent neurological deficit. One case was managed successfully without surgery. Fifty percent of all cases have been reported in the past 5 years. With the increasing use of extradural techniques for anaesthesia and analgesia, this serious complication may be seen more frequently in the future.

Extradural abscess is a rare but recognized complication of extradural anaesthesia. Previous reports have been associated with a short time interval between extradural catheterization and presentation. We report a patient with rheumatoid arthritis, receiving steroid therapy, in whom an extradural abscess did not present until 23 days after the insertion of a thoracic extradural catheter to provide postoperative analgesia.

We performed vascularized rib grafts for anterior fusion of the thoracolumbar spine in 3 cases. Case 1: A 23-year-old female with an extradural abscess at the Th3-6 level. A 5cm vascularized graft obtained from the 6th rib was used for fusion from Th3 to Th6. Radiographically, bony fusion was observed two months after operation. Case 2: A51-year-old female with spinal tuberculosis at the Th7-11 level. A 7cm vascularized graft obtained from the 8th rib was used for fusion from Th7 to Th12. Radiographically, bony fusion was observed three months after the operation. Case 3: A50-year-old male with spinal tuberculosis at the Th9-L5 level. A 15cm vascularized graft obtained from the 9th rib was used for fusion from Th9 to L4. Although bony fusion was not observed at three months after the operation, correction of kyphosis was maintained. Vascularized rib grafts appear to be an easy method for anterior fusind of thoracolumbar spine and a useful treatment for cases with destruction involving multiple vertebral bodies and marked kyphosis.

✓ Two cases are reported of extradural abscess from guinea-worm infection, one that resulted in paraplegia, and the other in motor weakness of the legs.