title: Brain abscess after percutaneous therapy for trigeminal neuralgia.
abstract: We report a case of brain abscess following the percutaneous treatment for trigeminal neuralgia. This procedure envisages the access with a needle into the middle cranial fossa through the oral cavity. Thus, in this case, the bacterial infection can be more likely ascribed to the possible contamination of the needle inside the oral cavity rather than to other frequent and more controllable causes of infection like an imperfect sterilization of surgical instruments or an inadequate antiseptic preparation of both operator's hands and patient's skin. The subsequent brain abscess was treated with antibiotic therapy (Vancomycin 2 gr a day and Meropenem 8 g a day for 22 days before the surgical procedure and 30 days after, until complete normalization of laboratory parameters, clinical parameters, and neurological symptoms) and surgical drainage, although the culture of the abscess capsule and the purulent material resulted sterile. In conclusion, the percutaneous therapy for trigeminal neuralgia can be objectively related to risks, even if performed by expert hands. Therefore, it is important that the patient should be advised regarding risks/benefits and/or septic complications of such procedures, even if they occur very seldom. An association of surgery and antibiotic therapy results as effective treatment for this pathologic condition.
authors.affiliation: Neurosurgery Unit, Department of NESMOS, Faculty of Medicine and Psychology, University of Rome "La Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Acqui
authors.affiliation: Neurosurgery Unit, Department of NESMOS, Faculty of Medicine and Psychology, University of Rome "La Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Familiari
authors.affiliation: Neurosurgery Unit, Department of NESMOS, Faculty of Medicine and Psychology, University of Rome "La Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pesce
authors.affiliation: Neurosurgery Unit, Department of NESMOS, Faculty of Medicine and Psychology, University of Rome "La Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy.
authors.forename: Giada
authors.initials: G
authors.lastname: Toccaceli
authors.affiliation: Neurosurgery Unit, Department of NESMOS, Faculty of Medicine and Psychology, University of Rome "La Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035/1039, 00189 Rome, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Raco
references.citation: Neurochirurgie. 2009 Apr;55(2):197-202
references.pmid: 19298979
references.citation: Am J Ophthalmol. 2001 Feb;131(2):237-40
references.pmid: 11228301
references.citation: Neurosurg Rev. 1993;16(3):189-96
references.pmid: 8272207
references.citation: Pain Med. 2007 Sep;8(6):535-8
references.pmid: 17716329
references.citation: J Clin Pathol. 1985 May;38(5):558-60
references.pmid: 3998190
references.citation: Acta Neurol Scand. 1982 Jun;65(6):609-22
references.pmid: 7113666
references.citation: J Neurosurg. 2009 Apr;110(4):638-41
references.pmid: 18928354
references.citation: Surg Neurol. 2007 Nov;68(5):505-12
references.pmid: 17765958
references.citation: Acta Neurochir (Wien). 1997;139(4):373-4
references.pmid: 9202781
references.citation: Clin Neurol Neurosurg. 1980;82(4):269-72
references.pmid: 6263532
references.citation: Neurocirugia (Astur). 2005 Apr;16(2):177-82
references.pmid: 15915308
references.citation: Stereotact Funct Neurosurg. 2009;87(2):101-4
references.pmid: 19223696
references.citation: Neurosurgery. 1998 Sep;43(3):623-5
references.pmid: 9733320
references.citation: N Engl J Med. 1986 Jul 17;315(3):174-7
references.pmid: 3523243
references.citation: J Clin Neurosci. 2007 Jun;14(6):563-8
references.pmid: 17169562
references.citation: Acta Neurochir (Wien). 1985;74(1-2):61-7
references.pmid: 3976448
references.citation: Pain Pract. 2009 Jan-Feb;9(1):82-4
references.pmid: 19019055
references.citation: J Infect. 1995 Jul;31(1):55-7
references.pmid: 8522835
references.citation: Surg Neurol. 1992 Oct;38(4):280-2
references.pmid: 1440217
references.citation: Best Pract Res Clin Anaesthesiol. 2002 Dec;16(4):597-617
references.pmid: 12516894
references.citation: Ann Ophthalmol. 1990 Sep;22(9):339-40
references.pmid: 2248491
references.citation: Neurosurgery. 2001 Mar;48(3):524-32; discussion 532-4
references.pmid: 11270542
references.citation: Neurosurgery. 1996 Oct;39(4):853-5; discussion 855-6
references.pmid: 8880781
references.citation: Acta Neurochir (Wien). 1988;94(1-2):57-65
references.pmid: 3177047
references.citation: Infection. 2009 Feb;37(1):39-43
references.pmid: 19139814
references.citation: J Neurosurg. 1979 Nov;51(5):700-6
references.pmid: 501411
references.citation: J Neurol Neurosurg Psychiatry. 1987 Aug;50(8):1081-2
references.pmid: 3655825