Clinical improvement after untethering procedure of secondary tethered spinal cord [TSC] vs. primary TSC

To evaluate the surgical treatment of tethered spinal cord [TSC] in relation to the initial aetiology. Twenty-two patients suffering from TSC underwent untethering surgery fur their lesions between 2005 and 2006. Eleven patients were previously operated on for myelomeningocele [MM] at birth [group I] and 11 had primary TSC associated with skin signs of occult spine dysraphism [group II]. Age range was between 18 months and 11 years. Neurological disability was evaluated as moderate for both groups before surgery, and none of the patients, especially in group I, had complete paralysis. All the selected patients developed urinary dysfunction associated with motor weakness or aggravated their initial clinical status. All patients had preoperative neurological and urine function evaluation, then again at least 2 months following surgery. The follow-up period ranged from 2 months to 1 year. Postoperatively, in group I, 4 patients [36%] had improved urinary and motor functions. Three patients improved only motor function with stable urinary function [total motor improvement 63%]. Two did not show any changes, while 2 patients deteriorated. In group II, 6 patients [54%] improved their urinary and motor conditions after the untethering procedure, 3 patients improved their motor condition with a stable urinary function [total motor improvement 81%] and 2 did not show any changes. It seems that untethering operation may improve the clinical conditions for patients suffering from TSC but results of such a procedure are better in group II than in group I

Incidence of medulloblastoma in Syria

We operated on 130 children affected with medulloblastoma of the posterior fossa between the years 1990 and 2003. The age range was from 1.5 to 16 years [mean age of 7 years]. Seventy-two were male and 58 were female, the sex related ratio was M: F 1.25:1. All the children had elevated ICP signs on admission, but only 56.9% had either static or dynamic cerebellar syndrome. Computed tomography [CT] scans and magnetic resonance imaging [MRI] were performed prior to surgery, the CT scan was repeated in the first week postoperatively, and MRI was performed one month after surgery, then every 6 months during the follow-up period. Hydrocephalus was present in 85% of our patients. The tumour was located on the midline in 33% of patients, on the cerebellar cortex in 3%, in the cerebellar hemisphere in 18%, and was diffused in 46%. Two histopathological sub-types were identified, classic in 98 patients [75.3%] and nodular desmoplastic in 32 [24.7%]. Starting in the year 2000, all patients presenting with hydrocephalus, underwent an endoscopic third ventriculostomy prior to surgical removal of the tumour. Before the year 2000, 31 patients were shunted preoperatively, 41 patients operated on without any shunt and only 8 of those required shunting after tumour removal. All patients received radiotherapy and/or chemotherapy. Total resection was attempted in 76% of the cases; 10% showed a recurrence in the posterior fossa and 3% showed spinal or perioptical dissemination. The survival rate was 83% at one year, and 43% at 5 years