Meningitis Due to Enterobacter aerogenes Subsequent to Resection of Acoustic Neuroma and Percutaneous Endoscopic Gastrostomy Tube Placement: A Rare Nosocomial Event

Stereotactic radiosurgery, microsurgery, and expectant management of acoustic neuroma: basis for informed consent

There is diversity in the techniques and instrumentation used to perform stereotactic radiosurgery. The field continues to evolve rapidly, and improvements are being made in accuracy, effective radiation dose, and parameters necessary to maximize patient outcome. Stereotactic radio-surgery, like any other treatment modality, has advantages and disadvantages that must be discussed with a patient who has an acoustic neuroma or other skull base tumor. An informed decision to pursue observation,microsurgery, stereotactic radiosurgery, or a combination of these methods must be made, and it remains the responsibility of the surgeon to provide a balanced view of the relative advantages and disadvantages of each method.

Complication Rate of Transtemporal Hydroxyapatite Cement Cranioplasties: A Case Series Review of 76 Cranioplasties

OBJECTIVE

The objective of this study was to evaluate the complication rate of transtemporal cranioplasties using hydroxyapatite cement (HAC) for repair.

STUDY DESIGN

We conducted a retrospective case review of patients receiving HAC cranioplasties in the Acoustic Neuroma and Skull Base Surgery Program between July 1998 and December 2002.

SETTING

This study was conducted at a tertiary referral center.

PATIENTS

A total of 76 HAC cranioplasties were performed in 72 patients undergoing lateral skull base surgery. Patients undergoing anterior skull base surgery or those in which HAC was used for other reconstructive purposes were excluded from the study.

INTERVENTIONS

We studied transtemporal approaches for otologic procedures requiring cranioplasty.

MAIN OUTCOME MEASURES

Main outcomes measures consisted of complications requiring medical or surgical intervention.

RESULTS

Of the 76 HAC cranioplasties, two cranioplasty grafts became infected, requiring explantation. The first case involved a wound infection that extended into and involved the HAC graft; the second involved seeding of the HAC graft after meningitis after a percutaneous, endoscopic gastrostomy tube placement performed several days after the primary skull base surgery. This gives our series a wound infection incidence rate of 1.3% and an overall complication incidence rate of 2.63%.

CONCLUSIONS

This retrospective review provides the largest series to date evaluating the incidence of infection in HAC cranioplasties. Despite having a much larger series, our complication rate is the lowest published rate of HAC cranioplasty explantation, and the incidence of superficial wound infections reported here is consistent with the published data for neurosurgical and neurotologic procedures.