Spinal intramedullary tuberculoma

Spinal intramedullary tuberculosis is a rare disease entity. The authors report two healthy adult patients presented with progressive paraparesis due to histologically proven intramedullary tuberculomas. The spinal magnetic resonance imaging [MRI] scans revealed intensely enhancing intramedullary lesion. Surgery was performed through laminectomy and complete resection was achieved. Both patients improved after surgery with normal motor power and follow-up MRI showed complete excision

Pituitary apoplexy: evaluation of surgical results

This is a ten-year study comprised of 13 patients with a history of acute development of headache, nausea, or visual changes in the setting of a surgically verified haemorrhage into a pituitary adenoma. There were eight males and five females, with an average age of 39 years. Headache and vomiting were the most predominant presenting symptom in 77% of cases. Magnetic resonance imaging was a more powerful tool in the diagnosis of haemorrhage into a pituitary adenoma. Success in diagnosis was achieved in 100% of cases compared to 46% utilizing computerised tomography scanning. Improvement in visual acuity and visual field was noted in all surgically managed patients who presented with remaining vision. On the contrary, blindness at presentation carried a poorer prognosis. Only one of the three patients presenting with unilateral blindness improved to the pre ictal status. Ocular mobility abnormalities improved in all cases after surgery. It is concluded that pituitary apoplexy is a surgical emergency that needs rapid diagnosis, endocrine replacement, and early surgical decompression

Study of outcome of 40 cases of obsttructive hydrocephalus treated by endoscopic 3rd ventriculostomy

Forty patients [25 males and 15 females] with obstructive hydrocephalus were operated upon by endoscopic third ventriculostomy [ETV]. The age ranged from 4 months to 70 years, 17 were below two years. The cause of obstruction was aqueduct stenosis in 31 cases, three pineal body tumor and posterior fossa tumors in six. The main presentation was increase head circumference in patients below two years, while in patients above two years, the main presentation was that of increase intracranial pressure. Cerebellar manifestations either vermian or hemispherical were present in six patients. All patients were investigated by CT brain and in addition MRI brain was done in all cases of pineal and posterior fossa tumors [nine cases] and in another seven cases of aqueduct stenosis. ETV was done in all cases but the procedure was completed in 36, 24 improved, 2 unchanged, 10 deteriorated clinically. Deteriorated cases were nine of aqueduct stenosis pathology, seven of them were below two years of age and one case of posterior fossa medulloblastoma. Two cases were reoperated by ETV. Radiologically, after two years of follow up 18 cases improved, 10 deteriorated and 8 remained unchanged. Sixteen of the deteriorated and unchanged cases were of aqueduct stenosis and 13 were under two years of age. Apart from the case in which intraoperative apnea and collapse of brain, no major complications were reported in this study. It was concluded that ETV is a safe and effective method in cases of obstructive hydrocephalus

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

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