Evaluation of cerebrospinal fluid diversion procedures in treatment of pediatric midline posterior fossa tumors

Neurosurgeons still divided in their opinions concerning the best way to manage obstructive hydrocephalus secondary to posterior fossa tumors. Some authors proposed a preoperative indwelling cerebrospinal fluid shunt as the most advantageous method for the subsequent surgical approach to the tumor. Others proposed direct approach to the posterior fossa tumor, when possible, or external ventricular drainage, when necessary. This study aimed to evaluate the role of cerebrospinal fluid diversion procedures in treatment of hydrocephalus due to midline posterior fossa tumors in children. Eighty-eight patients were included in this retrospective study. They were classified into two groups: 22 patients operated for direct tumour attack without CSF diversion and 66 patients operated for CSF diversion before tumour attack. The later group was further subdivided into three subgroups according to the method of CSF diversion; V-P shunt, ETV, and EVD. This study carried out in the Neurosurgery Department, at Suez Canal University Hospital in the period between March 1995 and February 2005. The use of CSF diversion procedure was associated with improvement of hydrocephalus in 70% of patients while direct tumour attack was associated with improvement of hydrocephalus in 31% of patients. The best results were found in ventriculoperitoneal shunt [100%] followed by endoscopic third ventriculostomy [60%] then the external ventricular drainage [31%].The use of CSF diversion is beneficial in treatment of hydrocephalus due to midline posterior fossa tumour in children

Evaluation of aneurysm surgery of anterior cerebral circulation: clinical presntation, radiological as Sessment, Operative Factors and Overall Outcome

This study included 40 patients admitted in the departments of neurosurgery at University of Illinois at Chicago and Suez Canal University in Ismailia in the period from January 1997 to January 1999. The study described the clinical, radiological and surgical factors and their correlation with the overall outcome after surgery of aneurysms of the anterior cerebral circulation. Outcome was assessed using the Glasgow Outcome Scale at one and six months. Data analysis demonstrated that 25 patients [60%] were admitted after aneurismal rupture, while the remaining 40% had intact aneurysms. 55% of patients were normal at one month follow up or had been minimally or moderately disabled. This improved to 77.7% after 6 months follow up. Mortality was 14.8% after 6 months. Prognostic factors for poor outcome at one month follow up were Hunt and Hess and Fisher grading at admission, presentation with motor deficits, tight brain on exploration, difficult dissection of the aneurysm, intraoperative aneurismal leak or rupture, need for major brain resection during surgery, inappropriate clip placement, vasospasm and postoperative intracerebral hemorrhage

Results of microvascular decompression for hemifacial spasm

Ten patients with hemifacial spasm were included in this study. Right spasm occurred in three cases and left spasm in seven. The duration of symptoms ranged from 1-7 years and averaged 4 years. No patients underwent a previous procedure prior to MVD. The operative findings were vascular compression in all cases at the root exit zone. The source of compression was purely arterial in nine cases and mixed in one. No venous compression was found. One patient died and the survivals were spasm free in the immediate postoperative period; but in the median follow up, eight cases were completely spasm free and one had recurrence controlled by re-operation. The operative complications included the morality of one case, decreased hearing in another case and slight facial weakness in a third one. It was concluded that microvascular decompression for hemifacial spasm is a safe and effective method

Study of the effectiveness of gentamycin injection in disc space during lumbar discectomy in prevention of postoperative discitis

This prospective study was performed on 150 patients operated upon by lumber discectomy. Seventy-five cases were treated by an injection of 2 ml ampoule of gentamycin in the disc space that was removed; while in the other 75, 2 ml ampoule of sterile water was injected in the disc space. The study showed six cases of postoperative discitis, all in the placebo group, and three cases were diabetics. All cases were in L4-5 disc space. The frequency of discitis was 6/150. In gentamycin group, the frequency was 0%; while in the placebo group, it was 8%. It was concluded that the intraoperative prophylaxis with gentamycin is effective in the prevention of postoperative discitis

Anterior cervical fixation in type-II traumatic spondylolisthesis of the axis: a report of eighteen cases, and discussing the rationale of management

Eighteen adult consecutive patients with type-II traumatic spondylolisthesis of the axis were included retrospectively in this study. The average age was 32.5 years. Fourteen were males and 4 were females. The cause of injury in all patients was road traffic accident but in 2 patients was a fall. Preoperatively, all patients were neurologically intact except two; one was tetra paretic and the other one was atypical brown Sequard's syndrome. Associated head trauma was reported in 5 patients and other cervical fractures in 5 patients. All patients were treated primarily with anterior C2/C3 auto graft and plating after closed reduction. Reduction was complete and healing was uneventful in all patients. there plating after closed reduction. There were no reported morbidity or mortality. Hospital stay was 8 days in 15 patients including the time of closed reduction. Both paretic patients recovered with minimal gait difficulty. Proper typing and grading of hangman's fractures is mandatory for a better management. Early surgical fusion is recommended for hangman's fractures of the effendi-type II and III. Anterior plating is a simple effective choice for hangman's fractures. It shortens hospital stay and skeletal tractions time

Treatment of trigeminal neuralgia by microvascular de decompression

Fifty patients with trigeminal neuralgia were operated upon in Suez Canal University hospital, Al-Sahel Teaching hospital, and Al Azhar University hospital. Micro vascular decompression [MVD] was used in 42 cases, MVD and Rhizotomy in 3 cases, and Rhizotomy only in 3 Cases. The most common etiological factor was arterial loop compression [29 cases]. The superior cerebellar artery was the compressing factor in 24 cases. Thirty five patients had excellent outcome after MVD, 6 good, and 4 had poor outcome. MVD has proved to be an effective method for treatment of Trigeminal neuralgia