Transpedicular screws for fusion of the Lumbosacral spine in treatment of spondylolithesis

In this study, 62 adult patients presented with spondylolithesis received surgical treatment in the form of laminectomy, discectomy and removal of pars interarticularis with decompression of the nerve root on the symptomatic side and posterolateral fixation by transpedicular screws, in the period between July 1995 and January 2003. The patients were evaluated at an average follow-up period of 21 months. In this study females were 38 cases and males were 24 cases with the average age of both 42 years. The results were excellent in 34 cases, good in 15 cases, fair in 9 cases and 3 patients with poor results, still complaining of low back pain and sciatica

Recurrent meningioma: a clinico-pathological study

Nine recurrent cases out of 52 patients with meningioma were studied between 1986 and 2003 with follow-up for a mean of 38 months. The clinical presentation, diagnostic evaluation, management in the form of surgical resection and adjuvant therapy, such as radiotherapy, radiosurgery, hormonal and chemotherapy, were studied. Again, the factors affecting the recurrence of meningioma whether the age, sex, histopathologic pattern and the modality of surgical behavior at the initial surgery, whether it was total, radical or subtotal excision, were studied and evaluated. Although radiotherapy is partially effective and radiosurgery is promising, yet surgical radical excision of the recurrent meningioma is the corner stone and must be considered as far as possible

Traumatic spinal dorsal and / or lumbar fractures: Decision making and surgical approaches

The present study was carried out to study the feasibility and applicability of using different aspects of the patient's stability for deciding management and building up the optimum surgical procedure in cases of dorsal and lumbar fractures. Forty patients suffering from dorsal and lumbar fractures were assessed according to Frankel score and subjected to full medical, laboratory and radiological investigations. They were classified according to the concept of functional stability into definite stable, definite unstable and potential patient groups. Conservative and surgical management was decided according to these categories and the outcome was determined as improving, stationary or deteriorating. The results showed that definitely stable category included 12.5% of the patients. They were managed conservatively. While, definite unstable patients received surgical treatment. Twelve patients were in the potential group, where three continued the conservative plan and nine were operated upon after developing instability. 55% of the patients were stationary on discharge, 42.5% recorded 1-2 degrees of improvement and one case showed mild deterioration

Cervical spine trauma: etiology, management and outcome

The present work aimed to study Cx-Sp.T. regarding the etiology, available management lines and their reflection on the patient's outcome. Fifty patients of Cx-Sp.T. admitted to the Neurological Department over a period of 15 months from January 2000 to March 2001 [mean age 34.8 +/- 7.4 years, 38 males and 12 females] were included in this study. Immediate first aid, medical treatment and neck support were provided to every patient. Data about the trauma etiology were recorded. ASIA scale was used for a neurological assessment on admission. All patients were imaged with PI-X-ray, MRI was used once it possible [46 patients]. Skull traction was applied for all unstable cases. Anterior cervical decompression realignment and vertebral fixation using anterior plating and screws were performed in cases with bony fusion in almost all of them. Follow up continued for at least 12 months. The patients were classified, regarding their final outcome, based on ASIA scale into satisfactory, unsatisfactory or death. Road traffic accidents and falling from height accounted for 62% and 32% of the cases with two sport injuries and one due to assault. Initially, 24% of the cases suffered from complete cord syndrome, 64% had complete cord syndrome, while only 12% were neurologically intact on admission, 14% of the patients had no fractures. Stable and unstable fractures constituted 22% and 64% of the cases. Fifteen patients received conservative management, while 32 of the cases were operated upon. The outcome of the patients was satisfactory in 34% and unsatisfactory in 58% with 8% mortalities, three of them were immediate and one postoperative. Rapid commencement of accurately decided lines of management and neural decompression together with vertebral realignment and stabilization is crucial in lowering down the unsatisfactory results

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

Outcome of extradural haematoma: Clinico - Radiological, and operative correlation

20 cases of acute extradural Haematoma are reported, which were diagnosed among a total of 312 cases of head injury presented along 3 years in Mattarya Teaching hospital between 1995-1998. We correlated the outcome of the managed group according to different variables including-: age of the patients, initial GCS on admission, Tining of surgery after Trauma, and the radiological findings in plain x-ray and C.T. preoperatively. Conservative management was done to 3 cases depending upon: a]. Size of the Haematoma. measured in C.T. b]. Clinical picture. c]. Timing of presentation. d]. C.T. follow up. Our over all mortality rate in this series was 15 percent

Traumatic Acute Sub - Dural Haematoma: Clinico - Operative study Evaluation of Factors Affecting the Prognosis

25 cases of acute subdural haematoma [ASDH.] are reported, they were diagnosed among a total number of 327 cases of severe head injury in the ambulance center in Matariah Teaching Hospital between 1996-2000. Depending on CT scan finding as well as the clinical picture of the patients we have 3 groups of patients: group A in which acute sub dural haematoma is accompanied with brain laceration, group B in which the acute sub dural haematoma is accompanied with brain contusion, and finally group C in which there is only acute sub dural haematoma without brain laceration or contusion. It had been emphasized that the early surgical intervention, the rapid aggressive intensive management, the young age, and the absence of parenchymatous brain injury in the form of laceration, contusion and brain edema, are the factors which improve the outcome in these cases of ASDH

Growing skull fracture in children

Eight cases of growing skull fracture had been diagnosed and managed between June 1993 and December 2003 in El-Matareya Teaching Hospital and the National Institute of Neuromotor System [NINMS] in Cairo. Of the eight cases, six were males and two females ranging in age from three months to six years at the time of injury. All the patients presented with a scalp mass which was pulsatile and may be translucent on illumination. Symptoms and signs were seizures in two cases, hemiparesis in three cases and dysphasia in one case. The most common location was the parietal or either the fronto-parietal or the paritooccipital regions. The extent of the dural defect was always greater than that of the bony defect. Gliotic tissue was present in all the patients. Duraplasty was performed in all cases, cranioplasty was performed also for all patients to protect the underlying brain tissue. Follow up period was 4-30 months with a mean of 16 months for the evaluation of the results. Four cases were neurologically intact and four had neurological deficits