Assessment of endoscopic uses in transnasal transsphenoidal Approaches for pituitary tumors

Transsphenoidal approaches usually are the preferred method for treatment of pituitary tumor because of a lower risk of complications. Microscope alone has been used in treatment of such tumor. Recently, with minimal invasive surgery, endoscope has been introduced as an alternative and effective tool in transsphenoidal surgery. This study aims to evaluate the benefit of endoscopic alone or assisted microscopic transnasal transsphenoidal surgeries for pituitary tumors. Between January 2004 and till March 2006, 50 patients [26 males and 24 females] were surgically treated in three departments of neurosurgery. Assisted endoscopic surgeries were done in 38 patients and 12 had direct endoscopic resection. The majority of pituitary tumors patients were macroadenomas in 94% and 58% were presented with sellar and suprasellar extension. The common pituitary tumor was non-secreting adenomas [58%], followed by prolactinomas [18%], and unexpected metastasis [10%], while the least was Cushing disease [2%] and poly hormonal adenoma [2%]. The long term outcome revealed 58% of patients showed remission, 34% improved, 8% had stationary course, and no one had worsen of his condition. The incidence of diabetes insipidus [DI] in this study was relatively high 18% and 6% developed persistent DI after surgery. No recurrence rate was reported during follow up. Uses of endoscope in endonasal transsphenoidal surgeries for pituitary tumors are safe and effective in radical resection of the tumor

Lumbar Disc Surgery in Elderly

By virtue of modern neuroimaging, neurosurgeons are increasingly confronted by patients once deemed too old for lumbar disc herniation. Management of these patients is problematic, as the literature is relatively mute in regard to results and complications within this group. So, the purpose of this study is to review our experience in surgical treatment of elderly patients with this disorder and to provide a surgical reference for elderly regarding the safety of this surgery in terms of adverse perioperative events, duration of surgery, blood loss, surgery-related complications and hospital length of stay. The study included 45 patients in Suez Canal University Hospital from January 2003 to January 2005 diagnosed with lumbar disc prolapse and documented with MRI. The mean age was 66.5 years, 42% were females, 58% were males. The duration of follow up included short-term [1month] and long-term [9months]. The short-term results showed 90% success of pain relief [leg pain], while the long-term results obtained from patient questionnaire showed leg pain relief 85%, back pain relief 80%, satisfaction with surgery 82%, but return to activity 65% [lowest success rate]. The mean time spent in the hospital was 7.1 +/- 2 days postoperatively and the rate of significant complications was 8% [one case of CSF leak treated without surgery and three cases of wound infection lasted three weeks postoperatively for medical treatment]. Lumbar discectomy is relatively safe and highly effective in the elderly patients, with highly prevalent need for decompression of stenotic spine in addition to herniated disc. To resolve a persistently high failure rate we still need better patient selection and meticulous technique