Objective: Evaluation of the different surgical approaches applied in the management of tentorial meningiomas with special emphasis on pit falls, complications and final outcome with comparison to other series.
Method: This is a retrospective study of 13 patients with tentorial meningiomas operated upon by the authors in a period of 9 years with review of their perioperative planning .

Results: Thirteen cases of tentorial meningiomas included, 7 in posterior fossa, 4 tentorial leaflet ,one pineal region and one falcotentorial. Total excision was possible in 8 cases and almost total in 5 . There were 7 cases with good outcome (54%), 3 cases with fair outcome (23%), one case with poor outcome (7%) and 2 mortalities (15%).

Conclusion: Tentorial meningiomas being in an area closely related to eloquent neural and vascular structures, still represent a real challenge to neurosurgeons. In spite of the major advances in neurosurgical techniques all series of tentorial meningiomas still have a considerable incidence of morbidity and mortality. In this study it was found that the most important prognostic factor is the tumor size followed by the sidedness of the tumor .It was obvious that left sided tumors carry a higher incidence of morbidity and mortality.

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Between October 2003 and July 2006, 26 patients with various intrasellar and/or sellar-suprasellar lesions underwent endoscopic endonasal transsphenoidal surgery under our care. An endoscopic endonasal technique without the use of a transsphenoidal retractor or nasal speculum was employed in this series. In this paper we evaluate the safety and efficacy of the technique based on our preliminary experience. Eleven patients out of 15 harboring prolactinomas had a chemical cure, complete removal of the non-functioning macroadenomas was achieved in 75% of patients, and excellent visual outcome was achieved in 77.8% of patients. It is concluded that endoscopic endonasal pituitary surgery has definite advantages over the traditional method using the operating microscope. Improved visualization, angled view, and a wider panoramic perspective of the important anatomic relationships of the sphenoid and the sella turcica were the obvious advantages. The direct endonasal transsphenoidal approach is the most minimally invasive. Its advantages include wider access, avoidance of a septoplasty, and the ability for two surgeons to work together enabling better instrumentation and more complete and rapid removal of the tumor.

Objective: To evaluate visual outcome after surgical treatment of suprasellar meningiomas.
Methods: Retrospective series of 18 suprasellar meningioma cases had been operated at Alhussen university hospital in the period from June 2002 to June 2006.

Results: Among patients who underwent surgery for suprasellar meningioma, 1 experienced initial improvement in vision in both eyes, 8 experienced improvement in vision in one eye and maintained stable vision in the other eye, 2 experienced improvement in vision in one eye and worsening of vision in the other, 2 experienced worsening of vision in one eye and stable vision in one eye, and 4 maintained stable visual acuity in both eyes. (1 patient lost his vision in one eye postoperatively) No patient experienced postoperative worsening of vision in both eyes.

The orbitozygomatic approach is an important approach to many skull base lesions. Various authors have reported modifications to enhance the exposure provided by this approach. In this article the orbitozygomatic approach is used to approach different pathologies with maximal preservation of the superior and lateral walls of the orbit. The lateral part of the superior orbital fissure is also included in the orbitozygomatic osteotomy. The technique adopted in this paper is simple, provides wide exposure, does not need sophisticated equipment and gives a good cosmetic result.

Aim: To evaluate the effectiveness of cervical corpectomy in the management of cervical spondylotic myelopathy.

Patients and methods: This is a prospective study at the Department of Neurosurgery, Cairo University Hospitals, including fifteen cases of cervical spondylotic myelopathy due to double levels or more. All patients were subjected to anterior cervical corpectomy; one or more levels, followed by strut fibular graft, then augmented by anterior cervical locking plate in most of cases.

Results: Male: female ratio was 9/6, age (40: 65 yrs), myelopathies as 7 Brown sequard, 4 anterior syndrome, 2 central cord syndrome, 2 combined picture, radiculopathies in 12 cases, affected levels were C5/6 in all 15 cases, corpectomy was performed as single level in 3 cases, 8 double levels, 4 three levels, outcome 6 months postoperatively was 10 cases with improvement of clinical manifestation, 4 cases with stationary course and one case deteriorated clinically. Complications were superficial wound infection in graft site in 1case, one case of plate loosening one year after the operation.

Conclusion: Anterior cervical corpectomy or corpectomies are effective and safe method for management of multiple cervical spondylotic myelopathies.

Objective: The purpose of the study was to detect any specific risk factors for development of recurrent lumbar disc prolapse.

Patients and methods: This is a retrospective clinical analysis. Between 2004 and 2006, at the Department of Neurosurgery, Cairo University Hospitals, thirty two cases with recurrent lumbar disc prolapse were retrospectively studied and evaluated as regards their personal criteria, their clinical presentations, their MRI pictures, types of operations performed. Results: Males were affected more than females, diabetes mellitus was a significant risk factor in conjunction with smoking, young age at the first presentation was a significant risk, median period after the first operation was one year, the most constant symptom was sciatica, the most significant accurate investigation was MRI with contrast, conservative treatment had no role in recurrent lumbar disc, the most constant operative procedures were laminotomy, recurrent discectomy, and foraminotomy, outcome was very promising after operative intervention. Conclusion: Recurrent lumbar disc prolapse has certain associated risk factors for its development as, young age at first presentation, male gender with heavy working duties, diabetes mellitus, and smoking.

Aim of work: to provide a follow up data (neurological and general outcome) on the surgical success of one and two level anterior cervical discectomy and fusion and to determine the effect of plate fixation on the results. Material and methods: forty five patients with average age forty four years had anterior cervical discectomy for the treatment of degenerative disc diseases between January 2003 and May 2005. Thirty patients had cervical disc herniation at one level, (66.7%) and fifteen had disc herniation at two levels (33.3%). Fusion and plate fixation was done to twenty one patients and only twenty four had grafting without plate fixation, Thirty five of the patients had radiculopathy and ten had radiculomyelopathy. Outcome evaluation: clinical outcome were assessed with neurological assessment of motor power and sensory affection. The verbal rating scale (VRS), Nurick classification system for cervical spondylotic myelopathy and Odom's criteria.

Results: clinically there were 19 excellent results (42.2%), 17 good (37.8%), 6 fair (13.3), and 3 poor (6.7%) outcomes, there were significant improvement of pain postoperatively in all patients, radiculopathy group improved regarding their motor power but only 40% of patients with radiculomyelopathy had substantial improvement and 60% had partial improvement. There were no statistical difference in the final outcome between patients with single level or patients with two levels herniation p=0.11 or between patients who had grafting only or patients who had graft and plating p=0.53. Pseudarthrosis occurred in 8.3% of patients without plate fixation and no significant correlation could be detected between pseudarthrosis and age sex or neurological symptoms.

Conclusion: Anterior cervical discectomy with fusion at one or two segments is a reliable method of management for patients who have cervical radiculopathy or radiculomyelopathy. and the addition of plate fixation did not add to the satisfactory clinical outcome. The rate of recovery of neurological function can be high with careful preoperative neurological and radiological evaluation for proper patient selection.

Purpose: To report on the early results of percutaneous vertebroplasty of osteoporotic vertebral body compression fractures. Methods: The technique was used in 18 patients with 23 painful vertebral fractures. The technique involves percutaneous puncture of the involved vertebra (e) via a transpedicular approach followed by injection of polymethylmethacrylate (PMMA) into the vertebral body.

Results: The procedure was technically successful in all patients, with an average injection amount of 7 mL PMMA per vertebral body. No clinically significant complications were noted. Sixteen patients (89%) reported significant pain relief immediately after treatment. Conclusions: Vertebroplasty is a safe valuable tool in the treatment of painful osteoporotic vertebral fractures.

Objective: To clarify some technical notes on surgical management of idiopathic tarsal tunnel syndrome that we believe they may improve the surgical outcome. Methods: Eleven feet from nine patients with idiopathic tarsal tunnel syndrome were surgically treated in the period from January 2003 to December 2005. All the patients had trials of conservative treatment for more than 6 months without response. All the patients had preoperative neurophysiological studies, MRI, plain X-ray on the affected feet and lab. investigations. In all the patients, the flexor retinaculum was identified and carefully resected along its entirety with care to avoid cutting the medial calcaneal nerve. The medial plantar nerve was identified and traced along the margin of the sheath of the flexor hallucis longus. The lateral plantar nerve was followed into the abductor hallucis until its first branch. Any constricting fibrous bands to the nerve were carefully released. Dissection of the posterior tibial nerve from the accompanying vessels was done and a subcutaneous graft of fat was inserted between the freed vessels and the nerve to prevent nerve compression by the attached arteriovenous complex.

Results: There was postoperative complete resolution of pain in six feet (excellent result = 54.5%) and marked improvement in pain in five feet (good results = 45.5%). There was improvement in all patients with sensory disturbance, and the case with atrophy of the intrinsic muscle of the foot had improvement in the muscle bulk. Neurophysiological studies were done for all the patients six months postoperatively and they showed improvement in the distal motor latency of both medial planter and lateral planter nerves. Neither wound infection nor recurrence of symptoms was found during the follow up period (mean 15.7 months).

Conclusion: Total resection of the flexor retinaculum and dissecting the posterior tibial nerve until the first branch of the lateral planter nerve with releasing of any fibrous bands followed by neurovascular decompression produces very good results in patients with properly diagnosed idiopathic tarsal tunnel syndrome.

Objective: The objective of this study was to evaluate the role of percutaneous drainage using the Ommaya reservoir system (ORS) implanted stereotactically combined with radiation therapy as a therapeutic option in the management of grossly cystic craniopharyngiomas.

Patients and methods: Between January 2000 and August 2005, 22 patients were referred for stereotactic placement of ORS for drainage of their cystic craniopharyngiomas. All procedures were performed at Neurosurgery Department, Ain Shams University, Cairo, Egypt. Patients were selected on the basis of having their CT scan and MRI disclosure of: 1) Purely or predominantly unilocular cystic craniopharyngioma, either primary or recurrent. 2) The craniocaudal dimension of the cyst was at least 2cm. 3) The cyst wall was not too thick or calcified to be punctured. There were 12 males and 10 females vary in age from 7 to 52 years (mean: 17.5 years). Four patients (18.2%) had ORS placement as a primary treatment while 18 patients (81.8%) had undergone prior craniotomy. Nine patients (40.9%) had purely cystic tumors while the other 13 patients (59.1%) had mixed tumors. Twenty patients (90.1%) received external radiotherapy (RT).

Results: Eighteen patients (81.8%) showed significant clinical improvement in the early post-operative period. No procedure related morbidity was encountered. Eight patients (36.4%) showed spontaneous regression of their cysts. Twelve patients (54.5%) required multiple aspirations for symptomatic recurrence of their cysts; nine of them (40.1%) finally stabilized and the remaining 3 patients (13.6%) continued to require infrequent aspiration at intervals ranged from 4 months to one year. Two patients (9.1%) required frequent aspiration every one to 2 weeks even after finishing a complete course of radiation therapy (RT). Two patients (9.1%) eventually required revision of their ORS. Four patients (18.2%) necessitated subsequent craniotomy. Two patients (9.1%) died at 2 and 5 months post-operatively. At the time of the final evaluation of the 16 patients (72.7%) who survived without subsequent craniotomy (mean follow-up of 25.1 months), all were clinically stable compared to their early post-operative status except 3 children who developed late diabetes insipidus. The overall cystic tumor control rate was 90% while the overall solid tumor control was 72.7%.

Conclusion: Treatment of cystic craniopharyngiomas by percutaneous aspiration via ORS implanted stereotactically combined with radiation therapy can be considered as a definitive treatment option in cases of recurrent grossly cystic or primary purely cystic tumors.

Objective: This study was done on 40 patients having extramedullary cord tumor (nerve sheath tumor and meningiomas) to evaluate the clinical presentation, investigation, surgery, post-operative outcome and recurrence. Patients: This study was carried out on 40 patients having diagnosis of spinal nerve sheath tumors or meningiomas and treated in the period between 1999 and 2005. The medical records of patients, such as their clinical presentations, neuroradiological findings, operative reports, functional outcome, complications and recurrence, were evaluated. The average age of these 40 patients was 38±13 years. Female sex predominated slightly in meningiomas while male sex slightly predominated in nerve sheath tumors.

Results: The average duration of symptoms until admission for surgery was significantly shorter for patients with nerve sheath tumors (22.1±23 months) than for patients with meningiomas (25±15 months). Complete tumor removal was achieved in 60% of the patients; 74.1% in nerve sheath tumors and 30.8% in meningiomas. Resection of a clinically relevant nerve root was done in 14 cases of nerve sheath tumors; 2 (14.3%) in the cervical, 5 (35.7%) in the thoracic and 7 (50.0%) in the lumbar regions. Post-operative complications occurred were CSF leakage in 7 cases (25.9%) of nerve sheath tumors and in 4 cases (30.8%) of meningiomas, while wound infection was observed in 1 patient (3.7%) of nerve sheath tumors and 2 patients (15.4%) of meningiomas.

Conclusion: Early diagnosis and surgery is the preferred management in cases of spinal nerve sheath tumors and meningiomas due to its associated excellent functional improvement and low recurrence rates. Surgical transsection of the nerve root carrying nerve sheath tumors will lead to radical removal and less incidence of recurrence; but this must be weighed against the risk of spinal cord damage.