ABSTRACT
Objectives: To evaluate the demographic characteristics, surgical safety in addition to highlighting major complications in 1525 consecutive patients who underwent microscopic inter-laminar discectomy electively at King Hussein Medical Center
Methods: A series of 1525 consecutive patients underwent elective inter-laminar lumbar discectomy, during a 5-year period [January 2009 to January 2014] in our neurosurgical department, are analyzed retrospectively. Demographic features evaluated: Age, gender, site of surgery. In addition to general and specific complications encountered
Results: Lumbar discectomy surgeries operated more commonly in male patients constituted with a percent of 64 % of all lumbar discectomies considered in this study, and it was more common in the age group between 40-60 year-old patients .The most common level operated was L4/L5 level, followed by the L5/S1 level. With a recurrence rate of 4.9% in all over levels operated, unintended durotomy occurred in 7.9 % of the surgeries, superficial wound infection and deep wound infection occurred in 3%, 0.5% respectively and the mortality rate was 1/1525
Conclusion: Five-year follow-up demonstrate effective interlaminar approach in treatment of herniated lumber disc with comparable complications to reported incidences worldwide. Demographic features were in line with reported results in terms of gender and age groups and slit deference regarding level of disc herniation
ABSTRACT
Objective: The aim of this study is to share our protocol and experience in the management of cases of Spontaneous CSF Rhinorrhea cases
Methods: This is a retrospective study of 50 consecutive patients [21 male: 29 female] who presented with spontaneous CSF leak from March 2003 to March 2013 and were managed in the neurosurgical department in King Hussein Medical Center [KHMC]. The investigations, site of leakage, line of management taken, mortality and morbidity were reviewed and studied
Results: All our patients presented with spontaneous rhinorrhea, 6 female patients were diagnosed to have Idiopathic Intracranial Hypertension [IIH] and one male had obstructive hydrocephalus and all were treated by CSF diversion. Forty-three patients had CT and MR cisternography: in 16 patients the site of the leak was apparent and were subjected to direct surgical repair, 27 patients whose cisternography was negative were managed in a stepwise protocol: the first step was medical treatment to decrease CSF production and restricted activities for 10 days, the second step is external lumbar drainage [ELD] insertion for the non-responders by the 3[rd] day and was used in seven patients, and the third step is permanent CSF diversion and was used in two patients where the leak recurred after the discontinuation of the drain. No treatment-related mortality or morbidity. No late recurrences
Conclusion: Good results can be achieved in managing cases of spontaneous CSF leak, this can be done by categorizing the patients who have increased intracranial pressure or not. Leaks secondary to high intracranial pressure are managed by diversion procedures, while detectable defects are best managed by direct repair and in other cases a stepwise management is appropriate
ABSTRACT
Objective: The aim of this study is to describe our experience with cranioplasty plus using implantable biomaterials in repairing calvarial defect, and to highlight its necessity in treating this serious condition
Methods: The authors retrospectively reviewed and analysed 107 patients who were operated at King Hussein Medical Centre, during the period between Jan. 2004 and Jan 2015, the final study included 84 patients with acquired skull defects of variable size from [3x4cm to 10x13 cm] and location
Results: cranioplasty using titanium plate or bone cement procedure was technically successful and feasible. Defects were attributable to different pathologies: post depressed fracture 34 cases [40.5%], trauma with decompressive surgery 21 cases [25%], bone tumour 13 [15.5%], infected flap 7 [8.3%], growing skull fracture 9 [10.7%]. The procedure achieved successfully the targets of providing protection for the regions of the brain in 85.7% of cases, by reconstructing the harmonic contours of the damaged cranium and give it anaesthetic appearance. However, the observed complication rate was 14.3% overall in our study [n=12], which included three cases of flap infection, sterile wound dehiscence one case, subgalial collection 4 cases, exteriozation of repair material 2 cases, and loosening of repair material 2 cases
Conclusion: Cranioplasty using Titanium mesh and bone cement was found to be adequate in achieving the wanted goals by re-establishing the integrity of cranium defect, restoring the anatomic and aesthetic deformity, eliminating the risk of traumatic insult to the brain, and relieving the psychological stress of patients and families with a high success rate 85.7%.Cranioplasty is considered simple and safe surgery, however, associated with some complications. Titanium mesh graft repair seems to be easier surgical procedure