Decompressive craniectomy for spontaneous intracerebral hematoma, does it add benefit?

Background: Many studies discussed the validity of hematoma evacuation versus conservative treatment, and little research discussed the role of decompressive craniectomy in the management of SICH. The purpose of the study is to discuss the role of decompressive craniectomy alone in selected cases of supratentorial SICH and comparing it with the reported results of best medical treatment in the literatures. Patients and methods; Fourteen patients harboring SICH with mass effect were operated in Zagazig University Hospitals by decompressive craniectomy from March 2015 to September 2017. Inclusion criteria were hypertensive supratentorial SICH with massive edema and midline shift and GCS score below 10. Wide decompressive craniotomy was performed together with duroplasty. Patients were followed for 6 months postoperatively using modified Rankin scale (mRS). Results: There was 14 patients, 9 males and 5 females with mean age 69.7 (range 56 to 81), 8 right and 6 left sided hematoma with mean GCS of 7 (range 4 to 10), preoperative midline shift ranged from 9 mm to 15 mm (mean 12.7). Early postoperative follow up showed improvement of GCS mean 11 (range 6 to 15) and midline shift mean 3 mm (range 1 to 9) in the first 24 hours. At 6 months, mortality rate was 2/14. GOS showed good outcome (mRS 0-4) in 10 patients and poor outcome (mRS 5-6) in 4 patients. Conclusion: Decompressive craniectomy with duroplasty is an effective method for management of supratentorial SICH and is better than the best medical treatment in selected cases

Revision surgery in lumbar degenerative disease

Introduction: Lumbar degenerative disease is a common health problem all over the world and the need for revision surgery is still high with variable results. The aim of the work: Is to evaluate the clinical and radiologic outcome in cases of redo surgery for lumbar degenerative pathology and to specify which pathology is responding well to revision surgery.Patients and methods: Forty eight patients were operated upon for revision of previous failed back surgery in Zagazig University Hospitals from August 2014 to April 2017. Selection of patients for revision surgery depends on confirmed radiological and clinical compression or instability. All patients were operated and followed for at least 6 months after surgery. VAS score was used as a tool for evaluation of back and leg pain.Results: There were 48 patients; with a mean age of 46.7 years (range 22-78).There were 29 males and 19 females. The dominant symptoms were unilateral sciatica in 30, bilateral in 11, low back pain in 23 patients.Neurogenic claudication was present in 4 cases. Type of surgery was redo discectomy in 31 cases, revision decompression for spinal canal stenosis in 4 cases, and posterior lumbar interbody fusion in 13 cases, with success rate of 96.8%, 75% and 84.6% respectively regarding improvement after surgery.Conclusion: Revision surgery of lumbar degenerative diseases gives excellent results provided that the patients are properly selected