Go KO, et al. Brain Tumor Res Treat. 2023 Jan;11(1):47-58. https://doi.org/10.14791/btrt.2022.0044

Background: No dural substitute has proven to be complication-free in a large clinical trial, even suggesting some benefit during watertight closure. However, primary dural closure is not always possible due to dural shrinkage from electrocautery for dural bleeding. Objective: This study is performed to analyze the clinical outcomes related to cerebrospinal fluid (CSF) leakage after microvascular decompression (MVD) using a simple surgical technique. Methods: Three hundred and sixty consecutive cases were treated with MVD and followed up for more than one month after surgery. Bleeding from the cut veins during dural incision was controlled by pulling stay sutures instead of electrocautery to avoid dural shrinkage. Additionally, a wet cottonoid was placed on the cerebellar side dural flap to prevent dural dehydration. During dural closure, primary dural closure was always attempted. If not possible, a “plugging muscle” method was used for watertight dural closure. Results: The mean age was 54.1 ± 10.8 years (range, 24–85 years), and 238 (66.1%) were female. Primary MVD was performed in 345 (95.8%) patients. The mean operation time (from skin incision to skin closure) was 96.7 ± 33.0 min (range, 38–301 min). Primary dural closure was possible in 344 (95.6%) patients. The “plugging muscle method” was performed more frequently in patients older than 60 years (8 of 99 cases, 8.08%) than in younger cases (8 of 261 cases, 3.07%) (p = 0.039; chi-squared test). After surgery, 5 (1.4%) patients were treated for middle ear effusion, and another 5 (1.4%) patients experienced transient CSF rhinorrhea, which was spontaneously resolved within 1 to 7 days. No patients required additional treatments for CSF leakage. Conclusion: A simple technique using pulling stay sutures to stop bleeding from the dural edges and placing a wet cottonoid on the exposed dura can make primary dural closure easier.

Song Y, et al. Brain Tumor Res Treat. 2024 Oct;12(4):230-236. https://doi.org/10.14791/btrt.2024.0030

Lee E, et al. Brain Tumor Res Treat. 2025 Apr;13(2):45-52. https://doi.org/10.14791/btrt.2024.0045

Ventriculitis has a poor prognosis, and treatment is technically challenging. We describe a case of ventriculitis in which bilateral continuous extraventricular lavage was performed and review the previously published literature on the treatment of ventriculitis using extra-ventricular drainage (EVD). A 75-year-old woman lost consciousness while undergoing intravenous meropenem treatment for a submandibular abscess. Contrast-enhanced brain magnetic resonance imaging (MRI) revealed ventriculitis and fluid collection with diffusion restriction at both occipital horns of the lateral ventricles and third ventricle that indicate empyema. She was referred to the neurosurgery department for an emergent operation. An extra-ventricular drainage catheter was inserted bilaterally at Kocher’s point. Since ventriculitis was disseminated from the submandibular abscess and intravenous meropenem as empirical antibiotics had been administered, meropenem-mixed saline was continuously dripped through one EVD catheter intraoperatively, and approximately 1 L of saline with antibiotics was drained until grossly clear fluid flowed through the other EVD catheter. MRI was performed 28 days postoperatively, and diffusion-weighted images showed a decrease in restriction, and the cerebrospinal fluid profile appeared to have improved. The ventriculoperitoneal shunt was performed 34 days after EVD lavage due to secondary hydrocephalus. Three months later, the patient was available for cane-gait and is currently undergoing follow-up without neurological complications. Continuous intraoperative lavage through bilateral EVD is relatively simple and maintains more aseptic conditions during the procedure. Although ventriculitis is fetal in patients, bilateral extraventricular lavage can be a relatively safe and effective conventional administration of antibiotics for ventriculitis.

Background and Objectives: The usefulness of extracorporeal membrane oxygenation (ECMO) therapy for acute respiratory distress syndrome (ARDS) in patients with traumatic brain injury (TBI), spontaneous intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH) is limited. This study aimed to investigate the survival benefit of ECMO in ARDS that developed during hospitalization in high-risk neurological patients. Materials and Methods: This retrospective study evaluated patients with TBI or spontaneous ICH and SAH admitted to our hospital’s neurosurgery intensive care unit and who received ECMO therapy for ARDS between March 2017 and March 2024. Clinicodemographic characteristics, indications for and methods of ECMO application, occurrence of comorbidities, hospital survival rates, and ECMO weaning success rates were compared between survivors and non-survivors. Results: Among the 16 patients evaluated, seven (43.8%) were successfully discharged. The mean ages of the survivor and non-survivor groups were 52.1 and 58.6 years, respectively. The PaO₂/FiO₂ ratio pre-ECMO was similar in both groups (66.6 vs. 69.2); however, it improved significantly post-ECMO in the survivor group (264.1 vs. 209.4). The ECMO success rate was 100% in the survivor group and only 33.3% in the non-survivor group. The intensive care unit and hospital lengths of stay were longer in the survivor group. Most patients received veno-venous ECMO, and hemorrhagic complications were rare. Conclusions: ECMO for ARDS in patients with severe TBI or spontaneous ICH and SAH positively impacts survival and functional recovery and may be a beneficial treatment modality.