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

Evaluation of endoscopic third ventriculostomy in the treatment of hydrocephalus in posterior fossa tumor

Endoscopic third ventriculostomy [ETV] has been shown to be a sufficient alternative in the surgical treatment of occlusive hydrocephalus. To elucidate the ongoing discussion of indication and surgical technique a prospective analysis of 10 consecutive ETVs was conducted. Ten of ETVs were performed [4 male and 6 female patients] in Suez canal university, their ages ranged from 4-24 years [mean age, 11.5 yr]. hydrocephalus was caused by posterior fossa tumor [mostly medulloblastoma]. Surgery had been done with rigid endosope with a working length of 30cm and an outer diameter of 2.4mm equipped with four channels for instruments. Suction and irrigation and ROD lens optics system. ETV was accomplished in all cases. The overall success rate was 100%. Complications were few included one case of intraoperative arterial bleeding, superficial skin infection also in another. There were no permanent morbidities or mortalities. ETV is the treatment of choice for obstructive hydrocephalus; ETV is most effective in treating uncomplicated occlusive hydrocephalus caused by posterior fossa tumors. Blunt perforation of the flour of third ventricle with dilatation by balloon catheter is the preferred method to accomplish free communication of CSF through prepontine cistern, continuous training and meticulous technique are essential to avoid ETV complications which are few but sometimes fatal

Prospective controlled study of carbon fiber cage fusion compared with iliac crest autograft fusion in anterior cervical discectomy

Anterior cervical discectomy is an effective and safe treatment for nerve root or spinal cord compression caused by disc herniation or spondylosis. Cervical interbody fusion allows preservation of the physiological lordosis and stability of cervical spine. The complications of autogenous bone grafting leading neursurgeons to seek altenative methods for cervical spine fusion. This prospective study was conducted to evaluate the safty and efficacy of using carbone/ fibre cage fusion compared with the widely performed iliac crest autograft fusion. This controlled study included 22 patients with cervical disc disease. All the patients underwent magnetic resonance imaging. The first 11 consecutive patients and iliac crest autograft; the next 11 patients had carbone fibre cages filled with sponge bone from minute incision along the iliac crest, all patients had follow up for 9 months. The demographic and clinical data were compared, the evaluation of neck and arm pain did not indicate statistical significant difference between either groups. According to Odom criteria, 10 patients [90.9%] of 11 patients in both groups had good to excellent functional recovery. Fusion was present after 9 months in 10 patients [91%] of 11 patients had iliac crest autograft and in 8 patients [72%] of 11 patients had carbon fibre cages. In iliac crest group, graft site pain reported in 5 patients [45%] persist for more than 4 months. In the cage group no complications related to iliac graft site as the incision minute and no complications related to cage extrusion and no cases of symptomatic pseudoarthrosis were observed. Interbody fusion cages used in anterior cervical discectomy have a load sharing function and stabilized the spine to increase segmental stiffness thus it constitutes a safe and efficient alternative to iliac crest bone autograft

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