Acute spinal epidural abscess: clinical presentations and surgical management

Spinal epidural abscess is a serious condition affecting males more than females causing spinal cord compression. Risk factors include imunocomprimise, septic lumbar puncture, or haematogenous spread of remote infections. The aim of this study was to highlight the common risk factors for epidural abscess and its management based on eliminating these factors. All patients in the present study underwent plain x-ray, CT scan of affected spine, MRI of the affected area of the spine, and bone scanning when needed. Once neurological symptoms appeared urgent decompression and evacuation of the pus with subsequent culture and sensitivity was done. Liver diseases and Diabetes Mellitus. Were the most risk factors among our patients. The lumbar spine was commonly affected than other areas of the vertebral column. Posterior laminectomy and decompression were done for 24 cases. Fluid puss collection was found in 21 patients whereas 3 patients had a fibrous granulation tissue. Discectomy and partial corpectomy were done when affection of the anterior column was found. Staph. Aurues was found in about 60% of the culture obtained from the abscess. Epidural abscess is best treated by urgent decompression and giving the appropriate antibiotic

Endoscopic anatomy of the sphenoidal air sinus

Advances in optics and endoscopic instrumentation have revolutionized endoscopic surgery for sellar and juxtasellar pathologies. Sphenoid sinus is more complicated than the other paranasal sinuses. Anatomical details of the sphenoid sinus relevant to utilizing the endoscope are very important. We aimed to study the anatomical variations of the sphenoid sinus in cadavers building up an experience that can aid application in clinical cases. An endoscopic study for the sphenoid sinus was carried out on 15 cadavers and 10 patients with pituitary adenomas during the microscopic removal of these adenomas. The results were discussed with particular reference to the important endoscopic, anatomical and surgical features of the sphenoid sinus. Anatomical variants can be identified endoscopically. Knowing about and expecting these variations have a great role in improving the surgical performance and the operative outcome

Endoscopic removal of third ventricular colloid cysts in non dilated ventricles

Colloid cysts are benign conditions forming not more than 1% of all intracranial neoplasm. The natural history of colloid cysts is not fully understood and the presenting manifestations are usually non specific. Many treatment options have been established for treating colloid cysts, the most recent of them is the endoscopic removal Although small or non dilated ventricles add difficulty to the procedure, yet it is not an obstacle against safe and complete resection. Between 2004 and 2007 we have operated on 10 cases of colloid cysts with non dilated ventricles [average or small sized]. Eight cases were females and two were males. The age ranged between 18 and 43 years. Headache was the outstanding symptom and occurred in all patients. Two patients suffered short term memory deficit. We used the Gaab endoscopic system with an outer sheath diameter of 6.5mm. We used neither neuronavigation nor stereotactic guidance. Follow up period ranged from 35 to 2 monthes. we were able to achieve total cyst removal in all cases. Mild transient short term memory deficit occurred in I patient. There was no mortality. Taping and working inside dilated ventricles are easier than that in smaller ones, however average or even small ventricles are not a contraindication against endoscopic colloid cyst removal even in the absence of neuronavigation and stereotaxy. Still the endoscope in small ventricles can be used safely, effectively with shorter operative period and shorter hospital stay when compared to the traditional operative techniques