Orbitozygomatic infratemporal approach to lesions of the cavernous sinus, orbit and the infratemporal fossa

Based on wide experience using different variations of the orbitozygomatic approach as an adjunct to the pterional craniotomy with the skull base group at University of Cincinnati Medical Center and the Mayfield Neurological Institute, this study utilized the total orbitozygomatic osteotomy approach in exposure and resection of complex skull base tumors in 5 patients at Ain-Shams University. The tumors have involved the area of the cavernous sinus, posterior orbit and the infratemporal fossa. The utilization of this approach achieved gross total resection in 4 cases and radical excision of an extensive chondrosarcoma of the skull base without significant morbidity in another patients. After reconstruction, there were no significant anatomic, functional or cosmetic deficits

Lateral mass plating in cervical spine injuries

In this study, the technique of lateral mass plating was used in the fixation of unstable cervical spine due to traumatic injuries in eight patients who had clinical and radiological evidence of instability. They were all injuries from C3 to C6 region. Seven patients were and remained neurologically intact and one patient had quadriplegia before and died one week after surgery as a result of complication of pulmonary embolism. All injuries were posterior ligamentous with subluxation due to unilateral or bilateral facetal injuries. Initially, stainless steel hardware was used, but titanium plates were used in the last two cases. There were no complications of nerve root or vertebral artery injury in the cases. One patient continued to have axial neck pain and C4 radiculopathy due to technical error and the patient refused surgery to revise his fusion. The technique has been appeared to be safe and effective for internal fixation of unstable cervical spine due to posterior ligamentous and facetal injuries. The technique required a complete understanding of the surgical anatomy and proper screw placement to avoid neurovascular injury

Surgical management of ruptured cerebral aneurysms

In this study, 20 patients with subarachnoid hemorrhage due to ruptured cerebral aneurysms. 2 patients were at Grade I, 13 patients were at grade II, and 5 patients were at grade III. 19 patients had anterior circulation aneurysms and one patient had basilar bifurcation aneurysm. 1 patient was operated with early surgery 3 days after subarachnoid hemorrhage. 14 patients underwent microsurgical clipping of their ruptured aneurysms during the period 4th to 14th day [intermediate surgery], and 5 patients were operated after 14 days [late surgery]. The outcome in this series with a follow-up period from 2 months to 21/2 years was good in 14 patients. One patient developed postoperative stroke due to occlusion of the superior trunk of the middle cerebral artery with fair result. 5 patients died with a mortality of 25%. The mortality in 3 patients was considered a management rather than operative due to high clinical grade [grade III', with postoperative delayed ischemia due to vasospasm. Technical problems occurred in 2 patients