Ct and MRI in the evaluation of ventriculo subgaleal technique for CSF diversion

The ventriculo-subgaleal technique for C.S.F. drainage was applied to 60 patients included in this study with acute hydrocephalus of variant etiologies. All patients were evaluated before and after shunt by CT and MRI to assess the degree and cause of hydrocephalus. The value and efficacy of V.SG Drainage Technique was verified both clinically in terms of Glasgow Coma Score in 93.3% and radiologically using the ventricular size index on serial CT scans in 95% of the cases. The V.SG.D replaced the external drainage for periods as long as 3 weeks with no risk of infection and lesser costs. 20% of the patients in this work proved to be shunt independent and V.SG.D has efficiently curved its temporary purpose during the acute phase of hydrocephalus. It also proved its reliability until a definite corrective surgery was performed

ventriculo subgaleal technique: a prolonged temporary aseptic technique for cerebrospinal fluid diversion

Sixty patients with acute hydrocephalus of variant aetiologies constituted the subject of this study. The ventriculo-subgaleal [V.SG.] technique for cerebrospinal fluid drainage was applied to all them. The value and efficacy of this technique was verified both clinically in terms of Glasgow Coma Score in 93.3% and radiologically using the ventricular size index on serial C.T. scans in 95% of the cases. The V. SG. Drainage replaced the external drainage for period as long as 3 weeks with no risk of infection and lesser costs. 20% of the patients in this work proved to be shunt independent and the V.SG. drainage has efficiently curved its temporary purpose during the acute phase of hydrocephalus. It also proved its reliability until a definite corrective surgery was performed. The V.SG. technique for C.S.F. drainage is an easy, safe and aseptic procedure that has been rightly reintroduced to the neurosurgical practice

Intracranial pressure monitoring after posterior fossa surgery

After posterior fossa surgery, hydrocephalus may persist or evolve. Proper management of this complication requires timely detection. Postoperative intracranial pressure monitoring has been used in ten patients harboring posterior fossa tumors. Only two patients ultimately had to be shunted. This tool has proved to be safe and reliable for early detection and management of persistent hydrocephalus following posterior fossa surgery

Pineal region tumours in pediatric age group

16 cases of pineal region tumors in the pediatric age group constitute the subject of this study. After thorough investigations both clinical, radiological and laboratory, they were all operated upon by a ventriculoperitoneal shunt to divert the cerebrospinal fluid. This was followed in 15 cases by the favored occipital transtentorial approach and in one by the supracerebellar infratentorial approach. The microsurgical bipolar suction irrigation technique was used in all cases. The aim was to decompress as much as possible of the lesion mounting to complete excision and to attain ample biopsy for tissue diagnosis. There were no surgical mortalities. The outcome was excellent in 14 cases, one surgical morbidity in a highly invasive tumor, one incident of transient visual field defect and only one mortality due to hematemesis 2 weeks postoperative

Solitary intracranial metastatic adenocarcinoma of gastrointestinal origin

Seven cases of solitary intracranial metastatic adenocarcinomas of gastrointestinal origin are the subject of this study. They are a rarity and constitute around 2.7% of all brain metastases. Inspite of the thorough preoperative investigations to exclude and search for a primary, the brain lesion was the only known cancer in their bodies and the clue to the nature and origin of these secondaries. The affected elderly patients had a hurrican like course with signs of increased intracranial pressure. The neuroradiological imaging elicited a subcortical site of a single cystic mass within an edematous background. All the cases were operated upon achieving total excision with an excellent outcome in four cases and a good result in the remaining three patients. The histopathological examination revealed in five cases a mucinous adenocarcinoma of colonic origin. The other two cases proved to be poorly differentiated adenocarcinoma. Their primaries revealed themselves clinically in the colon and pancreas, only after the cranial surgery. All the patients had whole brain radiation postoperatively and remained clinically and radiologically, in the follow up period of 6 months, without local recurrence

Hydatidosis of the central nervous system

Hydatid disease of the central nervous system is a rare entity with its different forms whether cerebral, cranial or vertebral. Seven cerebral forms and one vertebral are the subject of this study. Their mean age of presentation was 25.6 years equal sex distribution and all the cases from rural areas, having an average duration of symptoms of 1.5 years. Abdominal ultrasonography and chest X- ray, for other sites and organs involvement, were done even postoperatively in the nonanticipated cases and a P.M. In the single mortality of this study to confirm primary hydatidosis of the central nervous system in this series. C.T. Scan was the investigation of choice in the cerebral forms and surgical excision followed by long term medical treatment was done. The complications faced with were allergic reaction to inevitable spillage of the cyst contents and post-excision porencephalic cyst

Cerebella pontine angle epidermoids

Epidermoids of the cerebello-pontine angle are congenital lesions that grow attaining a large size over a more or less long duration. 15 cases of cerebello-pontine angle epidermoids are the subjet of this paper in young age [a mean age 26], with their main complaint being facial and other cranial nerves affection and a definite C.T. Scan picture, showing a homogenously hypodense lesion in the cerebello- pontine angle region with finger like processes unless small so as to be accidently faced with intraoperatively [3 cases]. The patients were operated upon through a suboccipital cranioctomy or temporobasal craniotomy or even both, with excellent outcomes using the microneurosurgical techniques of dissection and suction irrigation. Some postoperative complications were dealt with accordingly like aseptic meningitis and cerebrospinal fluid leak mainly