Clinical presentation and management of unilateral acute and chronic epidural, hematomas of posterior fossa

Posterior Fossa epidural hematomas [PFEDHs] was detect in 14 patients secondary to the head injury in the period from Jan. 1999 to Feb 2001 - the goal of this study was to analyze the differences in preoperative clinical presentation and management between a group of acute [8 patients] and a group of chronic [6 patients] of epidural hematomas of posterior fossa. In this study [chronic epidural hematomas was defined as a delay of more than 72 hours from the accident to surgery]. All patients were admitted to neurosurgery departments of Al Azhar university hospitals. C.T brain scan without contrast and with bone window was used as a tool for diagnosis, followed by surgical evacuation of the hematoma for all patients. The outcome and good recovery was obtained in 13 patients but only one patient died

Surgical management of superior sagittal sinus in parasagittal meningiomas. Experience with 25 cases and review of literature

Twenty-five patients having parasagittal meningiomas were subjected to surgical intervention and tumor excision. The clinical picture varied according to the location, mass effect and vascular compromise of the tumor along the superior sagittal sinus [SSS]. Magnetic resonance imaging [MRI], MRI venography and computed tomography [CT] were the main tools of investigation. The location of the tumors was 56% in the middle third, 36% in the anterior third and 8% in the posterior third. The SSS was found to be totally occluded in 28%, partially occluded in 24% and patent in 48% of the cases. Postoperatively, the patients were followed up clinically and radiologically with an average follow up period of 22.3 months. The outcome was excellent in 16 patients, good in five patients, poor in two patients and two deaths occurred. The recurrence rate was 8%. It was concluded that the management of the SSS and the cerebral veins draining into it is the primary consideration in the removal of parasagittal meningiomas. The surgical technique depended mainly on the location of the tumor and the degree of SSS involvement. The microsurgical venous anastomosis of the cortical veins and the sinus in the middle and posterior third tumors with partially involved SSS must be considered

Surgical outcome of one level anterior cervical discectomy with and without fusion. comparative study

Sixty patients having one level cervical disc prolapse were surgically treated through anterior approach cervical discectomy with and without fusion. The main symptoms and signs were neck pain [88.3%], radicular pain [96.7%], motor deficits [26.7%] and sensory deficits other than pain [70%]. Twenty-six patients had C5-C6, 19 had C4-C5, 12 had C6-C7 and three had C3-C4 disc herniation. Standard anterior approach cervical discectomy was performed for all cases. Autologous iliac crest bone grafts were used for 26 cases, while the rest of the patients did not receive grafts. The follow up period ranged from six months to three years [average 13 months]. The overall outcome was excellent in 20 patients, good in 32, fair in five and poor in three cases. There was no statistical significant difference between the outcome of both techniques [with and without fusion]