title: Abscess of the medulla oblongata in a toddler: case report and technical considerations based on magnetic resonance imaging tractography.
abstract: BACKGROUND
  We report a unique case of a toddler (the only one reported) successfully operated on for a medulla oblongata abscess and comment on the influence of neuroimaging modalities in the preoperative planning of the surgical approach.
  
  
  METHODS
  We report a case of a 20-month-old child with a solitary medulla oblongata abscess. The abscess appeared to be in close proximity to the anterior medulla oblongata, but preoperative planning based on diffusion tensor imaging (DTI) tractography motivated us to try to remove this lesion through a midline suboccipital approach. The ventral medulla oblongata abscess was surgically removed via a telovelar approach. At the anterior wall of the 4th ventricle, a fenestration was made with pus release and evacuation of the cavity. The child was discharged 1 week later with an uneventful and full recovery.
  
  
  CONCLUSIONS
  Modern imaging modalities of the nervous system can be very helpful in preoperative planning. Functional visualization of the nervous system provided by modern imaging techniques, such as the DTI tractography, can alter the classic topographic concept of surgical approach. In the case presented, approaching an anterior medulla oblongata abscess based on DTI tractography data, through a suboccipital midline transventricular approach, proved to be an effective and safe technique.
authors.affiliation: 1st Neurosurgical Department, Aristotle's University Hospital of Thessaloniki AHEPA, Thessalonica, Greece. arzoglouvasilis@yahoo.com
authors.forename: Vasileios
authors.initials: V
authors.lastname: Arzoglou
authors.forename: Luca
authors.initials: L
authors.lastname: D'Angelo
authors.forename: Michael
authors.initials: M
authors.lastname: Koutzoglou
authors.forename: Concezio
authors.initials: C
authors.lastname: Di Rocco
mesh_terms: D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001922:Brain Abscess / Q000188:drug therapy / Q000601:surgery*; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D007223:Infant; D008526:Medulla Oblongata / Q000601:surgery*; D000077731:Meropenem; D019635:Neurosurgical Procedures; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000601:surgery; D041181:Staphylococcus hominis; D013845:Thienamycins / Q000627:therapeutic use; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D013845:Thienamycins; D014640:Vancomycin; D000667:Ampicillin; D000077731:Meropenem