Tethered spinal cord syndrome: neurosurgical and radiological assessment

MRI was utilized as a mean modality for assessing and diagnosis of tethered spinal cord syndrome. This study was conducted on twenty children 12 boys and 8 girls selected from pediatric neurology, urology and neurosurgery outpatient clinic at Al-Azahar University Hsopitals, Al-Sahel teaching hospital and Insurance Hospitals. They were complaining of urinary incontinence associated with other neurological deficit, four cases had past history of surgical closure of lumber meningocele during neonatal life. Plain lumbosacral radiography revealed scoliosis and straightening of lumber lordosis in all cases, spina bifida in 15 cases, sacral agenesis in 4 cases, calcified spinal spur in one case. MRI showed short thickened filum terminal in all cases, associated with anterior sacral meningocele in one case, diastematomyelia another one case, lumbosacral swelling in 5 cases and postoperative spinal adhesion in 4 cases. MRI is the most ideal imaging modalities, Neonatal spinal ultrasound are helpful. All cases underwent filum terminale division. Dural graft was done in 4 cases. Lipoma excision in 4 cases. Dermoid cyst excision in one cases. Dissecting the epidural scar adhesion in 4 cases. Wound infection was the commonest postoperative complication occurring in 5 cases. Postoperative outcomes showed urinary symptoms improvement in 15 cases and of the motor function in 14 cases. The choice of radiological imaging modalities and operative approach and result will be discussed

Surgical, radiological and histopathological studies of cases of superficial glioma in children

The clinical, Radiological findings and the Surgical results of 20 patients with superficial glioma in children who were operated in the period from March 2004 to September 2006, 12 boys and 8 girls aged from 8 months to sixteen years old [mean age 12 years]. The patients were presented to neurosurgery, neurology, and pediatric outpatients clinics at Al-Azhar University Hospitals and Al-Sahel teaching Hospital, with repeated attacks of partial complex seizures of different time of onset and progressive course as increase of frequency and prolonged duration of fits. The disease duration expressed between seven months and two years since time of onset. The most common presentation was epileptic fits in all cases, and focal manifestations and increased intracranial pressure were 16 cases. Papilledema was found in the 8 cases, hemiparesis and hemianesthesia of the contra lateral side of the tumor in 11 cases. The most common site of the tumors were temporal lobe 14 cases. Complete tumor removal was accomplished in 18 cases. The most common radiological and histopathological diagnosis among these group of patients of this study were Gangliogliomas 6 cases, and Gangliocytoma 5 cases. Comparative radiological studies between CT [Computerized tomography], MRI [Magnetic resonance imaging] and histopathology were evaluated. Sensitivity, Specificity and accuracy were 83%, 87% and 89% in CT and for MRI were 87.8%, 91.5%, 93.3% respectively. Transcortical approach were done in most cases, post operative radiation therapy was used in one patient. The choice of the radiological modalities, surgical approach, and result will be discussed