Management of subependymal giant cell astrocytoma in patients with tuberous sclerosis

The clinical records, radiological investigations and operative notes of six patients who had been diagnosed as having the clinical triad of the tuberous sclerosis in the form of seizures, mental retardation and sebaceous adenomas, with the typical CNS finding that develops subependymal giant cell astrocytoma, and who subsequently underwent surgical removal of the lesion. From April 1998 to April 2004 at Nasr Institute Hospital. There were 4 male patients [66.67%] the mean age was 13 years and 2 female's patients [33.33%] the mean age was 18 years. Medical treatment was the first line of treatment by antiepileptic drugs to control the seizures, with dermatological treatments and other drugs to control the intracranial pressure. All cases were operated on because of evidence of the tumor growth on the serial radiological examination with signs of obstruction of the ventricular system. All tumors removed underwent neuropathological examination and disclosed typical aspects of subependymal giant cell astrocytomas. Using new neurosurgical techniques such as microsurgery to routinely excise a growing mass, before hydrocephalus appears

Role of titanium mesh in the reconstructive surgery after skull bone defects

The clinical records, radiological investigations and operative notes of twenty patients who had been diagnosed as having skull bone defects and who subsequently underwent surgical reconstructive technique with titanium mesh from April, 2000 to April, 2004 at Nasr Institute Hospital. There were 14 male patients [70%] the mean age was 36 years and 6 female's patients [30%] the mean age was 39 years. The initial presentation and the major clinical findings among these patients are skull bone defects for different causes; 80% of patients [16 cases] had past history of head injuries followed by skull bone defect, underwent the reconstructive procedure secondarily, as that reflected the timing of their referral, and 20% of the patients [4 cases] had oncology surgery was performed underwent reconstruction with the use of titanium mesh. In the present series of patients, the implant has been used for coverage of small, medium and large sized cranial defects in various locations. This experience suggests that the titanium mesh offers a safe, cosmetically equivalent alternative to standard other cranioplasty materials while ease of implantation shortens operation time and better quality of life for patients. We describe our surgical technique in which the titanium mesh is used and report our experience with it

Cerebral vasospasm detection by TCD after supratentorial brain tumours surgery

Serial transcranial Doppler ultrasonography [TCD] studies were carried out in 74 patients, who had been operated due to supratentorial brain tumours. Among 74 cases have been 32 gliomas, 21 meningiomas and 21 metastasis. The objective of this study was to assess if cerebral vasospasm develops by TCD after supratentorial brain tumour surgery. Vascular spasm was defined when mean flow velocities[MFV] exceeded 120 cm/s in MCA and 90 cm/s in ACA. In the most publications the MFV of 120 cm/s is accepted as lower limit for vasospasm in MCA[2, 3, 8] and this value is about 70% higher than normal value [40 - 60 cm/s]. The cerebral vasospasm has been stated in 16 cases [22%] - 11 gliomas, 4 meningiomas and metastasis out of 74 patients. The cerebral vasospasm has been more intense in ACA on the operated [lesion] side than in MCA and on the non-operated [opposite] side. Cerebral vasospasm should be taken into account as a cause of postoperative worsening also after brain tumour surgery

Managementof interacrnial arachnoid cysts

The clinical and radiographic findings , surgical treatment and outcome in 8 patients with intracanial cysts are reviewed , were done at Nasr Institute, within three years [between 1999 and 2002] .There were 3 females and 5 males, ranging in age from a 5 years to 56 years, six patients were children below the age of 15 years. The clinical presentation reflected the anatomical location of the lesions. Computerized tomography or magnetic resonance imagine scans were diagnostic in all cases, in addition to CSF study. Surgical intervention were done for all cases, by cystoperitoneal shunting with placement of a low pressure shunt. In addition to ventriculoperitoneal shunting in tow cases. There is one case came with history for initial operation consisted of craniectomy for fenestraion and drainag of posterior fossa cyst at Jordan and recurrence of the cyst occws. All cases discharged without any neurological deficit. The results in this series show that cystoperitoneal shunting is the treatment of choice for most intracranial aracnoid cysts

Percutaneous retrogasserian glycerol rhizotomy for multiple sclerosis-related trigeminal neuralgia

Approximately two percent of patients with multiple sclerosis [MS] develop trigeminal neuralgia. In multiple sclerosis, Plaque within brainstem may cause trigeminal neuralgia that is often poorly responsive to microvascular decompression. For multiple sclerosis trigeminal neuralgia patients who are refractory to medication regimens, percutaneous trigeminal operations have been advocated. This study was done at Johns Hopkins University Hospital in the United State of America. During the 4-years period from 1995 to 1998, 42 patients suffering from trigeminal neuralgia with MS were treated with percutaneous glycerol rhizotomies [28 females, 14 males, median age 54 years]. These patients represented a subset of 448 patients who had this procedure for trigeminal neuralgia during the same period. The majority of patients without MS were older; 72% above the age of 57 years. Percutaneous retrogasserian glycerol rhiztomy [PROR] is performed with the patient awake but under intravenous sedation. There was no major morbidity related to glycerol rhizotomy and no mortality. The pain relief occurred, it did so immediately in approximately half the patients, over 1-2 weeks in the other half. Detailed follow-up three months or more after surgery was available for all the patients. The follow-up 31 of these patients [73.8%] had complete pain relief and required no medications for trigeminal neuralgia. An additional five patients [11.9%] achieved pain control in conjunction with reduced medication intake. Six patients [14.2%] had inadequate pain relief although three initially had complete pain relief lasting 3, 5, and 10 months respectively. Two of these six patients with inadequate relief were uncontrolled with medication and required subsequent surgical procedures. The patients evaluated for any trigeminal sensory changes, a descriptive assessment of facial numbness was used. Thirty patients [71.4%] continued to have normal facial sensation after glycerol rhizotomy. Finally, single or repeated percutaneous glycerol rhizotomy is a safe, well tolerated, and efficacious procedure for most patients with trigeminal neuralgia related to multiple sclerosis. The development of marked facial hypoesthesia is rare, and usually only observed after multiple rhizotomies

Guidelines for management of minor head injury

The generally accepted definition of minor head injury includes Glasgow Coma Scale [GCS] scores of 13 to 15. However, many studies have shown that there is a heterogeneous pathophysiology among patients with GCS scores in this range. To assess the risk of a significant intracranial neurosurgical and neurological complication after apparently minor head injury, the authors collected data prospectively on 950 patients who had sustained a transient posttraumatic loss of consciousness or other neurological function and who had a Glasgow Coma Scale [GCS] scores of 13, 14, or 15 in the emergency room. This study is based on 950 consecutive patients admitted to El Hossin and Sayed Galal University Hospitals during the 14-month period beginning in April, 1996, and ending in May, 1997. Skull x-ray films and/ or CT scans were obtained in all patients in this study. Abnormal radiographic findings were defined as the following: 1] skull fracture [including depressed skull fracture]; 2] intracranial hematoma or contusion; and 3] traumatic subarachnoid hemorrhage. After evaluation in the emergency room, 538 [51.1%] patients were admitted and staying in the hospital. Some of these patients had relatively uncomplicated injuries that required neurological observation while other patients required a neurosurgical procedure. Neurosurgical interventions were defined as placement of an craniotomy for evacuation of a clot. Operative procedures were required in the 48 patients with minor head injury; there are 12 patients had depressed skull fractures, 14 patients had acute epidural hematoma and 22 patients had burr holes for chronic subdural hematoma. The results of this study showed that patients with lower GCS scores tended to have suffered more serious injury