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Cryptogenic osteomyelitis of the skull and intracerebral abscess
Abstract:
The authors report a rare case of cryptogenic osteomyelitis of the skull with an intracerebral and a subgaleal abscess. Total excision of the abscess extending from the cortical surface to the lateral ventricle led to ventriculitis and subgaleal cerebrospinal fluid collection. These complications could have been avoided by aspirating the abscess after removing the infected portion of the skull and the epidural granulation tissue. Neurosurgeons preferring to excise such an abscess should leave a small area of capsule at the base in order to avoid having to open the ventricle.
Insights
This case report details a rare skull infection (osteomyelitis) with abscesses. Complete abscess removal risks serious complications; partial excision with aspiration is recommended for safer outcomes.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Skull Base Surgery
Background:
- Cryptogenic osteomyelitis of the skull is rare.
- Intracerebral and subgaleal abscesses present unique surgical challenges.
Observation:
- A case involving extensive skull osteomyelitis with both intracerebral and subgaleal abscesses is presented.
- Total excision of the abscess, reaching the lateral ventricle, resulted in ventriculitis and cerebrospinal fluid collection.
Findings:
- Complete excision of the abscess carries a high risk of iatrogenic complications, including ventriculitis.
- Aspiration of the abscess after debridement of infected bone and epidural tissue is a safer alternative.
Implications:
- Neurosurgeons should consider less invasive techniques like aspiration to avoid complications.
- Preserving a small portion of the abscess capsule at the base may prevent inadvertent ventricular entry.