<strong>Background: </strong>Craniopharyngioma is a benign tumor which represents 2% - 3% of all intracranial tumors, there are two types: childhood type which affects children between 5 and 10 years and a...<strong>Background: </strong>Craniopharyngioma is a benign tumor which represents 2% - 3% of all intracranial tumors, there are two types: childhood type which affects children between 5 and 10 years and adulthood type which affects patients 50 - 60 years old. The presenting symptoms develop over years and include visual, endocrine, hypothalamic, neurological and neurophysiological manifestations. Surgery is the treatment of choice. Postoperative radiotherapy, gamma-knife and intra tumoral injection of chemotherapeutic drugs have been used as an adjuvant therapy in some cases. <strong>Objectives: </strong>In this study, we evaluated the role of endoscopy in assisting microscopic surgical removal of craniopharyngioma. <strong>Methods: </strong>Eleven patients were operated upon in Cairo University Hospitals, Egypt. All operations were done using microscope through the subfrontal approach. At the end of surgery, the endoscope was used to detect any residual tumor in the subchiasmatic and retrochiasmatic areas and to visualize the posterior part of the tumor which couldn’t be seen by the microscope to check if it was adherent to the hypothalamus and to evaluate whether to be removed or not. <strong>Results:</strong> The study included eleven cases, four of which were childhood type and seven adult type craniopharyngiomas. Total removal was achieved in six cases (five cases of adulthood type). Oumaya reservoir was inserted in five cases;ventriculoperitoneal shunt was needed in five cases. All cases suffered from temporary diabetes insipidus postoperatively, while only two cases developed permanent diabetes insipidus. Three cases presented preoperatively with pituitary hypofunction and two cases developed postoperative pituitary hypofunction, which necessitated hormone replacement therapy. <strong>Conclusion: </strong>Craniopharyngioma is one of the most difficult and challenging tumors for neurosurgeons due to its relation to optic nerve, hypothalamus and vascular system formed by Willis circle and its perforating branches. Endoscopy has a role in decision making after microscopic removal of craniopharyngioma.展开更多
<strong>Objective:</strong> To evaluate the role of expanded endoscopic endonasal approach in removal of clival chordomas. <strong>Patients &</strong> <strong>Methods:</strong> ...<strong>Objective:</strong> To evaluate the role of expanded endoscopic endonasal approach in removal of clival chordomas. <strong>Patients &</strong> <strong>Methods:</strong> Nine patients with clival chordomas were operated upon in Cairo University hospital from September 2015 to September 2018 using the EEEA a recurrent case and seven new cases were involved in these study and ten operations were done. All patients had preoperative neurological and radiological examination. The study was focusing on the approach, efficacy of tumor removal, reconstruction of the base and complications related to this approach. <strong>Results:</strong> Nine patients were operated in this study in which ten operations were done. It included six males (66.6%) and three females (33.3%) with age ranging from 4 years to 63 years with average age 40.7 years. Headache and diplopia were the most common symptoms found in six patients (66.6%). Brainstem affection was found in two patients (22.2%). Lower cranial nerves affection was found in two patients (22.2%). One case developed CSF leakage postoperatively (11.1%). Two patients underwent tracheostomy. We achieve total removal in four patients (44.4%), near total removal in one patient (11.1%) and subtotal tumor resection in four patients (44.4%). <strong>Conclusion:</strong> EEEA for clival chordomas is safe and effective approach regarding the results of the incidence of complications, and the percentage of tumor resection.展开更多
Objective: Many approaches have been used for surgical removal of olfactory groove meningioma (OGM) as pterional, bifrontal, interhemispheric, and frontolateral approach. We evaluated the role of unilateral subfrontal...Objective: Many approaches have been used for surgical removal of olfactory groove meningioma (OGM) as pterional, bifrontal, interhemispheric, and frontolateral approach. We evaluated the role of unilateral subfrontal approach for the removal of giant OGM “bigger than 6-cm”. Patients and Methods: Nine patients with giant OGM had unilateral subfrontal approach between 1st of January 2015 and December 2017 in Cairo University Hospitals. A retrospective study we done analyzing clinical data, neuroimaging, surgical result and extent of tumor resection. Results: Total tumor resection was achieved in seven cases “Simpson grade I and II”. Subtotal resection was achieved in two cases, one case there was enchasing of the anterior cerebral artery. The other case subtotal resection was achieved due to old age of the patient. The frontal air sinus and cribriform plate and ethmoidal sinus were repaired using fat, fascia lata and vascularized pericranium flab with the use of histoacryl: One case developed hydrocephalus which required the insertion of a ventriculo-peritoneal shunt. One case developed wound infection and meningitis which required medical treatment only. There is no case of CSF leak or mortality in our series. Conclusion: The unilateral subfrontal approach is a safe and efficient approach for removal of giant olfactory groove meningioma. It combines the benefits of the bifrontal, frontolateral and pterional approach with early access to CSF drainage and early attack of the blood supply of the tumor.展开更多
<strong>Introduction:</strong> Malignant middle cerebral artery (MCA) infarction is a devastating entity that is associated with up to 80% mortality. Decompressive Hemicraniectomy has been utilized to trea...<strong>Introduction:</strong> Malignant middle cerebral artery (MCA) infarction is a devastating entity that is associated with up to 80% mortality. Decompressive Hemicraniectomy has been utilized to treat brain swelling and mass effect secondary to these infarctions in an attempt to improve functional outcome. <strong>Aim: </strong>To evaluate the functional outcome of decompressive hemicraniectomy in management of malignant MCA infarctions. <strong>Methods: </strong>The study included 30 patients with malignant MCA infarctions operated upon by decompressive hemicraniectomy and duroplasty with pericranium or fascia lata graft in the period from June 2016 to January 2019. Pre-operative neurological condition, associated morbidity, location and extent of the infarction were assessed. Surgery was performed within 48 hours of the onset of stroke or 12 hours within deterioration of conscious level. Pre-operative CT scan as well as sequential post-operative CT was done. Functional outcome was assessed by the modified Rankin Scale (mRS) at the time of discharge and 3 months following surgery. <strong>Results: </strong>The study included 18 males and 12 females with a mean age of 54.7 years. The pre-operative GCS was <8 (5 - 7) in 11 patients and 8 or higher (8 - 13) in 19 patients. Good functional outcome (mRS 0 - 3) was achieved in 13 (43.3%) cases while poor outcome (mRS 4 - 5) occurred in 8 (26.7%) cases and mortality (mRS 6) occurred in 9 (30%) cases. <strong>Conclusion:</strong> Decompressive hemicraniectomy improves functional outcome in cases of malignant MCA infarction. Pre-operative GCS, age, volume of infarction, degree of midline shift, timing of surgery and associated morbidity are the most important factors affecting the outcome.展开更多
Introduction: There is increasing of the incidence of chronic subdural hematomas (CSDH), due to increase of the elderly population with increase of intake oral anticoagulation and antiplatelet drugs in this category o...Introduction: There is increasing of the incidence of chronic subdural hematomas (CSDH), due to increase of the elderly population with increase of intake oral anticoagulation and antiplatelet drugs in this category of patients. Seizures occur as a complication in 2.3% to 20.4% of the patients. There is a considerable side effect associated with using of anti-epileptic drugs (AEDs). Aim of the Study: To rule the value of prophylactic antiepileptic drugs in prevention of seizures after surgical evacuation of chronic subdural hematoma. Methods: A prospective controlled non-randomized study was performed on 26 patients with chronic or subacute subdural hematoma that was surgically evacuated through burr-holes from April 2017 to June 2019. We divided the patients into 2 groups: group A patients received prophylactic antiepileptic drugs for 6 month and group B patients didn’t receive prophylactic antiepileptic drugs and the 2 groups were observed to detect occurrence of post-operative seizures for 6-month follow-up after surgery. Medical history, demographic data and imaging characteristics were recorded. Results: Seizure prevalence for all patients during hospitalization and 6-month follow-up was zero among the 13 patients who received prophylactic anti-seizure medications, and was 1 (7.7%) among the 13 patients who didn’t receive prophylactic anti-seizure medications. Conclusions: The incidence of post-operative seizures in patients with chronic subdural hematoma operated upon by burr holes evacuation is low. The administration of prophylactic antiepileptic drugs decreases the incidence of seizures after evacuation of CSDH, but the difference was not significant. So prophylactic antiepileptic drugs should not be routinely given for all patients with CSDH operated upon by burr hole evacuation unless there is risk factor for seizure development.展开更多
Background: Spontaneous descent of the CSF (Cerebrospinal fluid) from the nose is called rhinorrhea. The causes are defects in bones of the base or meningeal tear. The surgical management is still a challenge. The sur...Background: Spontaneous descent of the CSF (Cerebrospinal fluid) from the nose is called rhinorrhea. The causes are defects in bones of the base or meningeal tear. The surgical management is still a challenge. The surgical repair is a must to prevent the complication which could be brain abscess, meningitis, or pneumocephalus. The available surgical management is either transnasal, or transcranial. The endonasal route represents an easy access but equally aggressive alternative and of limited access. Objective: We reviewed the clinical outcomes of thirteen cases of spontaneous CSF leakage managed by transcranial intradural approach. Patients and Methods: This is a retrospective study about the records of 13 patients who underwent transcranial intradural approach as a surgical management for spontaneous CSF rhinorrhea in our department in the period between November 2017 and October 2019. Results: CSF leakage stopped after initial surgery in 12 of 13 patients, giving a success rate of 92.3%. The remaining case did not agree for new surgery and the case resolved without surgery for this patient. Postoperative complications included superficial wound infection in one patient, and anosmia in one patient. No other neurological problems were encountered over the ten-months’ follow-up period. Conclusion: The transcranial route is the treatment of choice for patients with anterior cranial fossa spontaneous CSF rhinorrhea. A satisfactory surgical outcome depends on exact diagnosis, proper operative approach, and the surgeon’s skills and experience.展开更多
Introduction: Spontaneous spinal infection is an uncommon disease, although the incidence is increasing in the last years. Absence of specific symptoms, and delayed diagnosis result in high morbidity, and mortality. A...Introduction: Spontaneous spinal infection is an uncommon disease, although the incidence is increasing in the last years. Absence of specific symptoms, and delayed diagnosis result in high morbidity, and mortality. Aim of the Study: To assess the clinical status of the patients, laboratory markers of inflammation, radiological findings, causative organisms, methods of management and their outcome. Patients and Method: Prospective study of 14 patients having spontaneous spinal infection from April 2017 to June 2019. Results and outcome: The study included eight males and six females with mean age of 43.1 years. On Denis pain score, six patients were P5 and eight patients were P4. Fever was found in nine patients. As regards ASIA score, seven patients were ASIA score E (normal motor, and sensory function), six patients were ASIA score D and one patient ASIA score C. Nine patients were found to be diabetic. Laboratory markers of inflammation were elevated in all patients. Two patients were managed conservatively (14.3%) (two cases were TB infection). Twelve patients were managed surgically (85.7%), six of them were TB infection (50%), three were nonspecific infection (25%), one patient was Staph aureus, one streptococci, and one brucella contributing to (8.3%) for each. There was improvement of neurological condition as eleven patients became ASIA score E, and three D and pain had also improved in all patients, ten patients became Denis P1, and four P2. Conclusions: Early diagnosis of spontaneous spinal infection depends on clinical sense to detect patients with back or cervical pain associated with fever and elevated laboratory markers of inflammation. A diagnosis was proved by MRI. Not all cases of Spinal infection need surgery. The indication of surgery is the presence of neurological deficit, spinal instability and failure of medical treatment in case of severe pain. Tuberculosis was the commonest organism as it is endemic in Egypt.展开更多
文摘<strong>Background: </strong>Craniopharyngioma is a benign tumor which represents 2% - 3% of all intracranial tumors, there are two types: childhood type which affects children between 5 and 10 years and adulthood type which affects patients 50 - 60 years old. The presenting symptoms develop over years and include visual, endocrine, hypothalamic, neurological and neurophysiological manifestations. Surgery is the treatment of choice. Postoperative radiotherapy, gamma-knife and intra tumoral injection of chemotherapeutic drugs have been used as an adjuvant therapy in some cases. <strong>Objectives: </strong>In this study, we evaluated the role of endoscopy in assisting microscopic surgical removal of craniopharyngioma. <strong>Methods: </strong>Eleven patients were operated upon in Cairo University Hospitals, Egypt. All operations were done using microscope through the subfrontal approach. At the end of surgery, the endoscope was used to detect any residual tumor in the subchiasmatic and retrochiasmatic areas and to visualize the posterior part of the tumor which couldn’t be seen by the microscope to check if it was adherent to the hypothalamus and to evaluate whether to be removed or not. <strong>Results:</strong> The study included eleven cases, four of which were childhood type and seven adult type craniopharyngiomas. Total removal was achieved in six cases (five cases of adulthood type). Oumaya reservoir was inserted in five cases;ventriculoperitoneal shunt was needed in five cases. All cases suffered from temporary diabetes insipidus postoperatively, while only two cases developed permanent diabetes insipidus. Three cases presented preoperatively with pituitary hypofunction and two cases developed postoperative pituitary hypofunction, which necessitated hormone replacement therapy. <strong>Conclusion: </strong>Craniopharyngioma is one of the most difficult and challenging tumors for neurosurgeons due to its relation to optic nerve, hypothalamus and vascular system formed by Willis circle and its perforating branches. Endoscopy has a role in decision making after microscopic removal of craniopharyngioma.
文摘<strong>Objective:</strong> To evaluate the role of expanded endoscopic endonasal approach in removal of clival chordomas. <strong>Patients &</strong> <strong>Methods:</strong> Nine patients with clival chordomas were operated upon in Cairo University hospital from September 2015 to September 2018 using the EEEA a recurrent case and seven new cases were involved in these study and ten operations were done. All patients had preoperative neurological and radiological examination. The study was focusing on the approach, efficacy of tumor removal, reconstruction of the base and complications related to this approach. <strong>Results:</strong> Nine patients were operated in this study in which ten operations were done. It included six males (66.6%) and three females (33.3%) with age ranging from 4 years to 63 years with average age 40.7 years. Headache and diplopia were the most common symptoms found in six patients (66.6%). Brainstem affection was found in two patients (22.2%). Lower cranial nerves affection was found in two patients (22.2%). One case developed CSF leakage postoperatively (11.1%). Two patients underwent tracheostomy. We achieve total removal in four patients (44.4%), near total removal in one patient (11.1%) and subtotal tumor resection in four patients (44.4%). <strong>Conclusion:</strong> EEEA for clival chordomas is safe and effective approach regarding the results of the incidence of complications, and the percentage of tumor resection.
文摘Objective: Many approaches have been used for surgical removal of olfactory groove meningioma (OGM) as pterional, bifrontal, interhemispheric, and frontolateral approach. We evaluated the role of unilateral subfrontal approach for the removal of giant OGM “bigger than 6-cm”. Patients and Methods: Nine patients with giant OGM had unilateral subfrontal approach between 1st of January 2015 and December 2017 in Cairo University Hospitals. A retrospective study we done analyzing clinical data, neuroimaging, surgical result and extent of tumor resection. Results: Total tumor resection was achieved in seven cases “Simpson grade I and II”. Subtotal resection was achieved in two cases, one case there was enchasing of the anterior cerebral artery. The other case subtotal resection was achieved due to old age of the patient. The frontal air sinus and cribriform plate and ethmoidal sinus were repaired using fat, fascia lata and vascularized pericranium flab with the use of histoacryl: One case developed hydrocephalus which required the insertion of a ventriculo-peritoneal shunt. One case developed wound infection and meningitis which required medical treatment only. There is no case of CSF leak or mortality in our series. Conclusion: The unilateral subfrontal approach is a safe and efficient approach for removal of giant olfactory groove meningioma. It combines the benefits of the bifrontal, frontolateral and pterional approach with early access to CSF drainage and early attack of the blood supply of the tumor.
文摘<strong>Introduction:</strong> Malignant middle cerebral artery (MCA) infarction is a devastating entity that is associated with up to 80% mortality. Decompressive Hemicraniectomy has been utilized to treat brain swelling and mass effect secondary to these infarctions in an attempt to improve functional outcome. <strong>Aim: </strong>To evaluate the functional outcome of decompressive hemicraniectomy in management of malignant MCA infarctions. <strong>Methods: </strong>The study included 30 patients with malignant MCA infarctions operated upon by decompressive hemicraniectomy and duroplasty with pericranium or fascia lata graft in the period from June 2016 to January 2019. Pre-operative neurological condition, associated morbidity, location and extent of the infarction were assessed. Surgery was performed within 48 hours of the onset of stroke or 12 hours within deterioration of conscious level. Pre-operative CT scan as well as sequential post-operative CT was done. Functional outcome was assessed by the modified Rankin Scale (mRS) at the time of discharge and 3 months following surgery. <strong>Results: </strong>The study included 18 males and 12 females with a mean age of 54.7 years. The pre-operative GCS was <8 (5 - 7) in 11 patients and 8 or higher (8 - 13) in 19 patients. Good functional outcome (mRS 0 - 3) was achieved in 13 (43.3%) cases while poor outcome (mRS 4 - 5) occurred in 8 (26.7%) cases and mortality (mRS 6) occurred in 9 (30%) cases. <strong>Conclusion:</strong> Decompressive hemicraniectomy improves functional outcome in cases of malignant MCA infarction. Pre-operative GCS, age, volume of infarction, degree of midline shift, timing of surgery and associated morbidity are the most important factors affecting the outcome.
文摘Introduction: There is increasing of the incidence of chronic subdural hematomas (CSDH), due to increase of the elderly population with increase of intake oral anticoagulation and antiplatelet drugs in this category of patients. Seizures occur as a complication in 2.3% to 20.4% of the patients. There is a considerable side effect associated with using of anti-epileptic drugs (AEDs). Aim of the Study: To rule the value of prophylactic antiepileptic drugs in prevention of seizures after surgical evacuation of chronic subdural hematoma. Methods: A prospective controlled non-randomized study was performed on 26 patients with chronic or subacute subdural hematoma that was surgically evacuated through burr-holes from April 2017 to June 2019. We divided the patients into 2 groups: group A patients received prophylactic antiepileptic drugs for 6 month and group B patients didn’t receive prophylactic antiepileptic drugs and the 2 groups were observed to detect occurrence of post-operative seizures for 6-month follow-up after surgery. Medical history, demographic data and imaging characteristics were recorded. Results: Seizure prevalence for all patients during hospitalization and 6-month follow-up was zero among the 13 patients who received prophylactic anti-seizure medications, and was 1 (7.7%) among the 13 patients who didn’t receive prophylactic anti-seizure medications. Conclusions: The incidence of post-operative seizures in patients with chronic subdural hematoma operated upon by burr holes evacuation is low. The administration of prophylactic antiepileptic drugs decreases the incidence of seizures after evacuation of CSDH, but the difference was not significant. So prophylactic antiepileptic drugs should not be routinely given for all patients with CSDH operated upon by burr hole evacuation unless there is risk factor for seizure development.
文摘Background: Spontaneous descent of the CSF (Cerebrospinal fluid) from the nose is called rhinorrhea. The causes are defects in bones of the base or meningeal tear. The surgical management is still a challenge. The surgical repair is a must to prevent the complication which could be brain abscess, meningitis, or pneumocephalus. The available surgical management is either transnasal, or transcranial. The endonasal route represents an easy access but equally aggressive alternative and of limited access. Objective: We reviewed the clinical outcomes of thirteen cases of spontaneous CSF leakage managed by transcranial intradural approach. Patients and Methods: This is a retrospective study about the records of 13 patients who underwent transcranial intradural approach as a surgical management for spontaneous CSF rhinorrhea in our department in the period between November 2017 and October 2019. Results: CSF leakage stopped after initial surgery in 12 of 13 patients, giving a success rate of 92.3%. The remaining case did not agree for new surgery and the case resolved without surgery for this patient. Postoperative complications included superficial wound infection in one patient, and anosmia in one patient. No other neurological problems were encountered over the ten-months’ follow-up period. Conclusion: The transcranial route is the treatment of choice for patients with anterior cranial fossa spontaneous CSF rhinorrhea. A satisfactory surgical outcome depends on exact diagnosis, proper operative approach, and the surgeon’s skills and experience.
文摘Introduction: Spontaneous spinal infection is an uncommon disease, although the incidence is increasing in the last years. Absence of specific symptoms, and delayed diagnosis result in high morbidity, and mortality. Aim of the Study: To assess the clinical status of the patients, laboratory markers of inflammation, radiological findings, causative organisms, methods of management and their outcome. Patients and Method: Prospective study of 14 patients having spontaneous spinal infection from April 2017 to June 2019. Results and outcome: The study included eight males and six females with mean age of 43.1 years. On Denis pain score, six patients were P5 and eight patients were P4. Fever was found in nine patients. As regards ASIA score, seven patients were ASIA score E (normal motor, and sensory function), six patients were ASIA score D and one patient ASIA score C. Nine patients were found to be diabetic. Laboratory markers of inflammation were elevated in all patients. Two patients were managed conservatively (14.3%) (two cases were TB infection). Twelve patients were managed surgically (85.7%), six of them were TB infection (50%), three were nonspecific infection (25%), one patient was Staph aureus, one streptococci, and one brucella contributing to (8.3%) for each. There was improvement of neurological condition as eleven patients became ASIA score E, and three D and pain had also improved in all patients, ten patients became Denis P1, and four P2. Conclusions: Early diagnosis of spontaneous spinal infection depends on clinical sense to detect patients with back or cervical pain associated with fever and elevated laboratory markers of inflammation. A diagnosis was proved by MRI. Not all cases of Spinal infection need surgery. The indication of surgery is the presence of neurological deficit, spinal instability and failure of medical treatment in case of severe pain. Tuberculosis was the commonest organism as it is endemic in Egypt.
