Anterior surgical approaches for thoracolumbar burst fractures

The choice of optimal surgical procedure for thoracolumbar burst fractures remains controversial. To evaluate the results of anterior surgical approaches to thoracolumbar burst fractures as regard ease of the technique, safety and incidence of complications, postoperative stability and functional outcomes. A retrospective study of 18 patients with thoracolumbar burst fractures treated through an anterior surgical approach between March 2011 and 2012. We used both the Thoracolumbar Injury Classification and Severity [TLICS] score and the Load Sharing Classification score for selection of cases. Anterior corpectomy, grafting and Z-plate fixation were clone. Follow up of cases was documented as regard clinical and radiological results. There were 12 males and 6 females, with a mean age of 38.3 years. Falls were the most common cause. Tnmspleural thoracotomy approach done in 5 patients, thoraco abdominal approach in 9 patients and flank retroperitoneal approach in 4 patients. 2 patients died first day postoperatively due to DVT and pulmonary embolism. Satisfactory results occurred in 10 patients, 5 patients had no clinical improvement and Ipatient showed clinical deterioration. Anterior approach of the spine allows for one stage decompression, stabilization and deformity correction

Compound depressed skull fractures overlying dural venous sinuses

The purpose of this study was to characterize the patients with compound depressed skull fractures overIying dural venous sinuses clinically and radiologically and to discuss the patients' circumstances that favour conservative or surgical treatment, in addition to the outcome. Of 192 patients with depressed skull fractures admitted to our Neurosurgical Department, Assiut University Hospital between January 2004 to December 2005, 30 patients [15.6%] with compound depressed skull fractures over a dural venous sinus were prospectively studied. There were 27 [90%] males and 3 [10%] females. Eighteen patients [60%] were paediatrics [3- 18 yrs] while 12 [40%] were adults [20-60 yrs]. Twenty-four patients had a Glasgow Coma Scale [GCS] of 14- 15/15, 3 patients had a GCS of 9- 13 and 3 patients had a GCS of <8. Aetiological falls and motor vehicle accident were predominant in the paediatric group while among adults assault and motor vehide accident were predominant. The superior sagittal sinus was the most commonly involved sinus [28 out of 30 patients = 93.3%] with anterior injuries more common than posterior ones [26 out of 28 patients = 92.9%]. Thirteen patients [43.3%] were treated conservatively and 17 [56.7%] patients were treated surgically; either initially in 15 cases due to the presence of neurological deficit, underlying haematoma, egress or escape of intracranial contents and/or deep contamination, or later on in the other 2 cases due to development of intracranial hypertension. lntraoperative difficulty was experienced in 8 [47.1%] patients. Of those treated non-operatively, 3 [23.1%] patients developed wound infection while wound infection among those treated operatively was seen in 2 [11.8%] patients. There was no mortality and the neurological deficit was reversed with the aid of physiotherapy by time and the patients returned to their daily activities. Our opinion favours conservative approach to fractures involving a dural sinus, if the wound is not contaminated, as the risk of infection is low. Surgery exposes the patient to the very real risk of massive haemorrhage. In instances where there is a clear need for surgery adequate precautions should be taken. Computed tomographic venography is a reliable tool for demonstrating early sinus compression and/or occlusion that facilitates surgical decision. However, delayed intracranial hypertension is a possible complication and should always be considered in patients with the appropriate clinical findings in the follow-up period

Compound depressed skull fractures overlying dural venous sinuses

The purpose of this study was to characterize the patients with compound depressed skull fractures overlying dural venous sinuses clinically, radiologically and to discuss the patients' circumstances that favour conservative or surgical treatment in addition to the outcome. Of 192 patients with depressed skull fractures admitted to Neurosurgical Department, Assiut University hospital between January 2004 to December 2005, Thirty patients [15.6%] with compound depressed skull fractures over a dural venous sinus were prospectively studied, They were 27 [90%] males and 3 [10%] females. Regard the age, 18 [60%] were pediatrics [3-18 yrs.] while, 12 [40%] were adults [20-60yrs.]. Twenty-four patients had a Glasgow Coma Scale [GCS] of 14-15/15, while a GCS was 9-13 and <8 in 3 patients for each. Etiologically falls and motor vehicle accident were predominant in pediatric group while, among adults assault and motor vehicle accident were predominant. The superior saggital sinus was the most commonly involved sinus [28 out of 30 patients=93.3%] with anterior injuries more common than posterior one [26 out of 28 patients = 92.9%]. Thirteen patients [43.3%] were treated conservatively and 17 [56.7%] patients were treated surgically either initially in 15 cases due to the presence of neurological deficit, underlying haematoma, egress or escape of intracranial contents and/or deep contamination or later on in 2 cases due to development of intracranial hypertension. Intraoperative difficulty was experienced in 8 [47.1%] patients. Of those treated non-operatively 3 [23.1%] patients developed wound infection, while wound infection among those treated operatively was in 2 [11.8%] patients. No mortality occured, and the neurological deficit was reversed with the aid of physiotherapy by time and the patients returned to their daily activities. Our opinion favours conservative approach to fractures involving a dural sinus if the wound is not contaminated as the risk of infection is low. Surgery exposes the patient to the very real risk of massive haemorrhage. In instances where there is a clear need for surgery adequate precautions should be taken. Delayed intracranial hypertension is a possible complication when a depressed skull fracture overlies the saggital sinus and should always be considered in patients with the appropriate clinical findings in the follow-up period

Clinical series of intracranial arteriovenous malformations [AVMs]: prospective analysis of 25 consecutive cases

The purpose of this study was to assess demographic, clinical, and morphological characteristics as well as treatment and outcome of patients with brain arteriovenous malformations [AVMs]. Twenty five patients with brain arteriovenous malformations [AVMs] had been studied and analyzed over a two-year period [April 2004-Marsh 2006] and assessed regarding demographic characteristics, morphological characteristics of AVMs according to the Spetzler-Martin grading system, clinical characteristics [type of presentations], as well as the mode of therapy [surgery, endovascular treatment and/or radiosurgical treatment] and the outcome angiographically in term of nidus occlusion and clinically by using the Glasgow outcome score [GOS]. Twenty five consecutive patients with intracranial AVMs were enrolled in this study. Their ages ranged between the second and the sixth decades with maximum incidence during the fourth decade [40%]. They were 14 [56%] males and 11 [44%] females. AVMs were more common in the supratentorial region [84%] than infratentorial one [16%] and the majority of patients were in grade two [11 patients; 44%] and grade one [10 patients; 40%]. Clinically, the most common presentation was haemorrhage [13 patients; 52%] followed by seizure [7 patients; 28%]. The combination therapy was done in 18 [72%] patients where embolization plus radiosurgery were used in 13 [72%] patients while embolization plus surgery was used in 5 [28%] patients. Mortality rate was zero. Four [16%] patients developed complications related to management. Intracranial arteriovenous malformations [AVMs] can cause stroke when they rupture. Epidemiological and imaging research has found that about 50% of patients with AVMs present with haemorrhage, and the other 50% either present with non-focal symptoms, such as headache, seizure, or focal neurological deficit, or have no symptoms and the lesion is found during unrelated investigations. The aim of treatment is total obliteration of the malformation, because the general belief is that any residual AVMs might result in haemorrhage. Obliteration might be achieved completely and in most cases by multimodal therapy rather than by a single-mode treatment. Thus, a multidisciplinary approach to any detected AVMs is recommended. Since the risk of rebleeding is high, and it is the main cause of disability in patients with AVMs. Early treatment is recommended for those who have bled, and such treatment should begin as soon as is feasible