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Combined microsurgical fluorescence for optimizing resection in refractory empyema and cerebritis
Carlos Sánchez Fernández1, Bernardino Choque Cuba2, Mónica Rivero-Garvía3
1Department of Neurosurgery, University Clinical Hospital of Valladolid, Ramón y Cajal 3, St., 47005, Valladolid, Valladolid, Spain. carlos_san_fer@hotmail.com.
Purpose:
Due to the generalization of new microsurgical equipment, intraoperative fluorescence techniques have extended in neurosurgical practice, mainly in neurovascular and neuro-oncology patients. The aim of identifying pathological tissue and also differentiating from the normal brain helps neurosurgeons to approach other kinds of intracranial entities such as infections.
Methods:
It is described in the case of an 11-year-old patient who underwent a subdural empyema by performing a craniotomy and evacuation of the purulent collection. After a non-optimal evolution, a frontobasal meningoencephalitis was assessed with cerebral involvement and associated intracranial hypertension. Indocyanine green (ICG) was used in reintervention for demonstrating a great damage of cortical vascularization around the infected area as well as fluorescein (FL), which identified a large area of avascularized tissue.
Results:
Both techniques allowed a selective excision of the affected brain parenchyma while preserving viable parenchymal areas. Radiological evolution and clinical outcome were good.
Conclusions:
The identification of vascular patterns in brain lesions and the recognition of viable or necrotized tissues are suitable for a selective resection of the parenchyma, minimizing morbidity. Clinical outcome is related to a safe and effective management of inflammatory and infectious processes.
