Object: The study was aiming at comparing ACF which is a cervical motion preserving technique with the more conventional cervical discectomy and fusion (ACDF) for the same indication (unilateral cervical radiculopathy). Methods: Thirty patients with unilateral cervical radiculopathy who had failed conservative treatment for at least 6 weeks were randomly assigned to one of two groups of 15 patients and treated at Ain Shams University Hospitals by either anterior cervical foraminotomy (ACF) or anterior cervical discectomy and fusion (ACDF) (using autologous bone graft or cervical cage ). There were 15 patients in each group that had similar demographic and clinical features. Disc herniations and/or uncovertebral osteophytes were confirmed on CT scan and MRI.

Results: In accordance with Odom's criteria excellent or good results were achieved in the ACF group during a mean follow-up period of 11.5 months. A poor result was observed in only one patient, that had an unresolved radicular pain that required repeat surgery in the form of ACDF for a missed osteophyte at the operated level. The overall subjective patient satisfaction rate with this surgical procedure was 91.7% . Thirteen of the patients (86.7%) returned to work or their baseline level of activity within 3 weeks postoperatively. The above results and outcomes for the ACF procedure are favorable and comparable with the ACDF group. In accordance with Odom's criteria, excellent or good results were achieved in the ACDF series during a mean follow-up period of 15.4 months. A poor result was not observed. The overall subjective patient satisfaction rate with this surgical procedure was 96.7%. Thirteen of the patients (86.7%) returned to work or their baseline level of activity within 6 weeks postoperatively.

Conclusion: The advantages of ACF include direct decompression of the nerve root, and the preservation of the intervertebral disc and motion segment with favorable results comparable to those achieved by the conventional ACDF .Thus ِACF can be used as an alternative technique in selected cases.

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Background: Craniopharyngiomas account for 2-5% of all primary intrcarnial tumors. Although histologically benign and amenable to surgical treatment, its location and relation to vital nervous and vascular structures makes the feasibility of radical resection difficult even in the microneurosurgery era. Beside the difficulties experienced when performing tumor resection, postoperative complications and morbidity such as endocrinological imbalance, visual affection represent another point that makes craniopharyngioma total excision is a challenge.

Object: The goal of this study was to assess and analyze the surgical outcome and recurrence in surgically treated craniopharyngiomas. Patients and Methods: This prospective study evaluates 35 patients (21 males and 14 females) aged between 3 and 59 years who were surgically treated for craniopharyngiomas in Neurosurgery Department, Ain Shams University between 1995 and 2002. The evaluation of the effect of clinical, imaging, endocrinological, visual findings, and the surgical treatment, on the outcome and recurrence.

Results: 16 cases (85.7%) were children and 19 cases (54.3%) were adults. Headache and visual impairment were the most common presenting symptoms (58% and 22% respectively), most of the cases (45.7%) were between 2 and 4 cm in diameter. Calcification was seen in C.T. of 75% of cases. Hydrocephalus was found in 12 cases (34.3%), Total excision was done in 15 patients (42.9%), subtotal excision in 9 (25.7%), partial excision in 9 (25.7%) while aspiration was done in 2 cases (5.7%), 20 cases (57.2%)had morbidity in the form of hormonal disturbance, visual impairment, hypothalamic affection, subarachnoid haemorrhage, extradural hematoma, infection and hydrocephalus. The overall outcome was excellent in 6 cases, good in 13 cases, fair in 10 cases, poor in 2 cases and 4 cases died. Conclusion: Preoperative visual and endocrinological state is the main determinant of post operative visual and endocrinological outcome. Extent of tumor excision is a major determinant of outcome and recurrence. Extent of tumor excision and hence outcome and recurrence are affected by size of the tumor, site and extension of the tumor.

Objective: This study was designed to evaluate the efficacy of video assisted endoscopic thoracic sympathectomy in management of primary hyperhydrosis and to assess the postoperative morbidity , patient's satisfaction and quality of life .Patients and Methods: The study comprised 25 patients of primary hyperhydrosis 9 females and 16 males, the mean age was 26.8 4.1 years. There were 17 patients (68%) presented with palmar-plantar hyperhydrosis, 2 (8%) with axillary hyperhydrosis, 2 (8%) with craniofacial hyperhydrosis & 4 patients (16%) with combined type. All patients were underwent video-assisted endoscopic thoracic sympathectomy procedures to treat hyperhydrosis. The extension of resection of thoracic sympathetic ganglia was according to the type of hyperhydrosis. Operative results, complications, patient satisfaction as well as the results after the follow up period were determined to be evaluated.

Results: The mean operative time was 47.2 8.9 minutes. The mean postoperative hospital stay was 2.3 0.8 days. Twenty patients (80%) were discharged with satisfactory results. 5 patients (20%) developed compensatory hyperhydrosis; 2 (8%) of them had tolerable compensatory hyperhydrosis and 2 patients (8%) developed unilateral transient Horner's syndrome. The patients were followed up one year postoperatively. The quality of life was better or much better in 20 patients (80%), no improvement in 2 patients (8%) and 3 patients (12%) become worse because nurse and a second operation was done in 2 patient (8%) due to recurrence there was no early or late morality.

Conclusion: It could be concluded that video assisted endoscopic thoracic sympathectomy is very effective in the treatment of primary hyperhydrosis with no mortality, minimal morbidity and durable long-term effect.

With the advent of anterior skull base and endoscopic sinus surgery and because of the nature of trauma to this area, the number of patients with CSF rhinorrhea and meningoceles has increased. This presents a serious and sometimes lethal medical problem. Advances in endoscopic techniques have resulted in repair of anterior skull base defects with transnasal endoscopic method. In this prospective study, twenty patients with cerebrospinal rhinorrhea were operated on using transnasal endoscopic approach. The charts of all patients treated were reviewed.

Results: 20 patients, 8 women (40%) and 12 men (60%), were included in the study. Patients' ages ranged from 3 to 65 years (mean: 38.6 years). Etiology, site of leakage, diagnosis, technique, cause of failure and follow-up are discussed.

Conclusion: The authors concluded that transnasal endoscopic surgery for CSF rhinorrhea had high success rate, low morbidity and stable long-term results.

Background: Post discectomy disc space infection is relatively uncommon. The anterior approach has been the traditional surgical approach for treatment of this complication. Posterior approach was sometimes added for instrumentation only.

Purpose: To present the results and clinical outcome, at a minimum of twelve months, following transforaminal lumbar interbody fusion (TLIF) and posterior instrumentation for post-discectomy spondylodiscitis. Study design: A case series. Materials and Methods: Nine patients (age 38- 68 years; mean: 47.8 years) with post-lumbar discectomy spondylodiscitis, were treated surgically by TLIF and posterior spinal instrumentation. All patients had significant back pain despite a full conservative treatment regimen by broad spectrum antibiotics and brace. The follow-up ranged from 12 to 36 months with an average of 22 months. All patients were available for follow up which included physical examination, scoring of function and radiographs. Outcome measures: To assess the invasiveness of the operation, we evaluated operative time, blood loss, and complications. Visual pain analogue scale (VPAS), activities of daily living (ADL) (Barthel index), CRP, and ESR in the preoperative, postoperative and final follow-up periods were used to evaluate the surgical outcome.

Results: Although we encountered some postoperative complications including wound infection; at the final follow-up visit, VPAS and Barthel index improved in all patients. Changes in CRP and ESR revealed suppression of infection in all cases.

Conclusion: Surgical treatment for pos- discectomy spondylodiscitis with TLIF and posterior spinal instrumentation provides patients with satisfactory final outcomes.

Purpose: Treating patients with malignant gliomas has always been a difficult task. We are investigating the efficacy of using cisplatin as radiosensitizer during standard course of radiotherapy followed by Lomustine (CCNU), and Vincristine (Oncovine) chemotherapy and the possible improve survival. The primary end of this study was time to progression, the secondary end points were response, toxicity, and the overall survival. Patients and Methods: After surgery (open debulking surgery, stereotactic craniotomy, or stereotactic biopsy), the adult chemo-naïve patients who were pathologically proven to have high-grade glioma i.e. anaplastic astrocytoma (AA), and Glioblastoma multiforme (GBM) were eligible. They received cisplatin 35mg/m2 weekly during radiotherapy, which was given conventionally 5 days a week, 200 cGY per treatment to a maximum dose of 6400 cGY. This was followed by 6 cycles of chemotherapy that consisted of CCNU 100 mg/m2 D1 every 6 weeks and vincristine 1.4 mg/m2 D2 and 23.

Results: Thirty- two patients were evaluable (the mean age was 50.97 years, range 19-70 years; Karnofsky performance status KPS was 90 in 11 patients, 80 in 10, 70 in 5, and 60 in 6 patients. The median time to progression TTP was 11.5 months (range 4-20 months), the mean was 15.66 months (range 4-28 months). Among the 32 patients, 5 complete responses and 25 partial responses were obtained, with an over all response rate of 93.7%. Among 175 doses of chemotherapy delivered, the most common grade 3and 4 toxicities reported were Neutropenia in 5 patients(15.7%), thrombocytopenia in 3 patients (9.4%), nephrotoxicity in one (3.1%), and ototoxicity in another one patient.

Conclusion: This protocol of using Cisplatin as a radiosensitizer during radiotherapy followed by CV chemotherapy appears to be active in the patients with high-grade gliomas with an acceptable toxicity profile.

Objective: Prolactinomas account for approximately 30% of all pituitary adenomas and 50 to 60% of functional pituitary tumors. Giant prolactinomas are often encountered in surgical practice presenting with hyperprolactinemia, local mass effect and pituitary apoplexy. The aim of this study was to assess the role of surgery and/or medical treatment in the management of giant prolactinomas. Methods: Ten cases of giant prolactinomas managed at the neurosurgery department, Alexandria University were reviewed. The different clinical, endocrinological and imaging features before and after treatment were reported and analyzed.

Results: Following initial surgery for VP shunt placement and craniotomy for tumor resection, headache and symptoms of elevated intracranial pressure disappeared in 67% and were ameliorated in 33%. Following medical treatment, clinical recovery occurred for cranial neuropathies in 100%, visual field defects in 30%, amenorrhea in 57% and galactorrhea in 100%. Tumor volume reduction occurred completely in 60% and partially in 40% with a mean volume reduction of 83.3%. Prolactin levels returned to the normal state in 50%, decreased to less than 100 ng/ml in 30% and between 200-500 ng/ml in 20%.

Conclusion: Medical treatment with dopamine agonists constitutes a first-line therapy for giant prolactinomas which is effective in controlling hyperprolactinemia and shrinking tumor size. Surgery is indicated for tumor resection in patients with medical failure or medication intolerance as well as for CSF diversion in patients with obstructive hydrocephalus.

Introduction: The term dystonia refers to twisting movements that are sustained at their peak and frequently repetitive. As stereotactic techniques improved over the previous decades, basal ganglia surgery was performed for a variety of movement disorders including dystonia. This study was done to evaluate the outcome and complications of stereotactic pallidotomy procedure for treatment of generalized dystonia. Patients and Methods: This is prospective study done on 10 patients with generalized dystonia treated by MRI guided stereotactic pallidotomy. They were selected according to inclusion and exclusion criteria among all patients presented with movement disorder to Ain Shams University hospital from January 2002 to January 2006. Fahn-Mersden (BMF) scale was used for assessment of the degree of dystonia in the preoperative examination and during each follow up visits.

Results: The patients' age at the time of surgery ranged from 10 years to 39 years old with a mean age of 20.3+ 6.8. There were six female and four male patients. Six patients were diagnosed as secondary dystonia. The mean preoperative dystonia score for all patients according to BFM scale was 67.3. There was a statistically significant decrease in dystonia score in both early and late follow ups in comparison to the pre-operative score in both primary and secondary dystonia.

Conclusion: Although most patients with generalized dystonia should be dealt with multidisciplinary approach of all the involved specialties, including the neurologist, neurophysiologist, and physical therapist, the neurosurgeon can help also those patients by many procedures including stereotactic pallidotomy that was proved to be effective and safe modality of treatment.

Objective: to evaluate an alternative minimal invasive craniotomy for skull base lesions. Methods: Between 2000 and 2005, 22 selected patients with anterior skull base lesions,divided into 2 groups: Group I (cranial base lesions n=9), included olfactory groove menengiomas n=6, chordoma n=1, esthesioneuroblastoma n= 1, lymphoma n=1, and Group II (sellar-suprasellar lesions,n=13 included (craniopharyngiomas n=6, pituitary adenoma n= 2, chiasmal glioma n=1, suprasellar fibrillary astrocytoma n=1, planum spheniodale menengioma n=2, suprasellar menengioma n=1). All patients underwent surgical intervention in the form of minimal invasive craniotomy either supra-orbital-subfrontal approach; n= 10 patients, (tumor size ? 4 cm,) or supra-glabellar approach; n= 12 patients, (tumor size > 4 cm). The study included 8 males, and 14 females, age ranged between 7 -75 years (mean age 44ys). Follow up period ranged between 6 - 60 months. All patients underwent preoperative CT brain, MRI brain and angeography in vascular lesions. Postoperatively, all patients underwent CT and/or MRI brain.

Results: Of the 9 patients with cranial base lesions, 4 patients reported visual improvement after surgery (44.4%), 3 patients reported no change in visual function (33.4%), and 2 patients showed worse vision postoperatively (22.2%). Postoperative MRI showed total removal in 6 patients (66.6%); in 3 patients removal was subtotal (33.3%); and one patient died postoperatively. Of the 13 patients with sellar-suprasellar lesions, postoperative visual improvement occurred in 8 patients (61.5%); 3 patients reported no change in visual function (23.1%), and worsening of vision occurred in 2 patients (15.4%). Postoperative MRI scans, showed total tumor removal in 8 patients (61.5%), subtotal removal in 5 patients (38.5%), and one patient died postoperatively.

Conclusion: Minicraniotomy for skull base lesions is applicable. It offers equal surgical possibilities with minimal brain retraction, allowing quick and minimally invasive access to the tumor with less brain exposure, and comparable results to standard approaches. In addition, the small skin incision, and small craniotomy result in a pleasing cosmetic outcome.

Objective: to evaluate an alternative minimal invasive craniotomy for skull base lesions. Methods: Between 2000 and 2005, 22 selected patients with anterior skull base lesions,divided into 2 groups: Group I (cranial base lesions n=9), included olfactory groove menengiomas n=6, chordoma n=1, esthesioneuroblastoma n= 1, lymphoma n=1, and Group II (sellar-suprasellar lesions,n=13 included (craniopharyngiomas n=6, pituitary adenoma n= 2, chiasmal glioma n=1, suprasellar fibrillary astrocytoma n=1, planum spheniodale menengioma n=2, suprasellar menengioma n=1). All patients underwent surgical intervention in the form of minimal invasive craniotomy either supra-orbital-subfrontal approach; n= 10 patients, (tumor size ? 4 cm,) or supra-glabellar approach; n= 12 patients, (tumor size > 4 cm). The study included 8 males, and 14 females, age ranged between 7 -75 years (mean age 44ys). Follow up period ranged between 6 - 60 months. All patients underwent preoperative CT brain, MRI brain and angeography in vascular lesions. Postoperatively, all patients underwent CT and/or MRI brain.

Results: Of the 9 patients with cranial base lesions, 4 patients reported visual improvement after surgery (44.4%), 3 patients reported no change in visual function (33.4%), and 2 patients showed worse vision postoperatively (22.2%). Postoperative MRI showed total removal in 6 patients (66.6%); in 3 patients removal was subtotal (33.3%); and one patient died postoperatively. Of the 13 patients with sellar-suprasellar lesions, postoperative visual improvement occurred in 8 patients (61.5%); 3 patients reported no change in visual function (23.1%), and worsening of vision occurred in 2 patients (15.4%). Postoperative MRI scans, showed total tumor removal in 8 patients (61.5%), subtotal removal in 5 patients (38.5%), and one patient died postoperatively.

Conclusion: Minicraniotomy for skull base lesions is applicable. It offers equal surgical possibilities with minimal brain retraction, allowing quick and minimally invasive access to the tumor with less brain exposure, and comparable results to standard approaches. In addition, the small skin incision, and small craniotomy result in a pleasing cosmetic outcome.

Background: The standard AO technique for posterior correction and instrumentation of thoracic scoliosis, using Universal Spinal System (USS) II, entails the use of pedicle hooks distributed along the upper and middle regions of the thoracic curve and pedicle screws only at the base of the construct.

Purpose: To assess thoracic scoliosis correction when pedicle screws are used instead of pedicle hooks and compare the results with the standard technique. Study Design: Prospective radiographic data review. Patients and Methods: Two patient groups were studied. All patients had structural thoracic scoliosis. Group 1: 14 patients (9 female and 5 male) with mean age of 14.6 years, were treated with posterior correction of scoliosis using the standard USS II technique with pedicle hooks and screws. Group 2: 14 patients (11 female and 3 male) with mean age of 15.3 years were treated using pedicle screws alone to correct the apical deformity, using a variation of the original USS technique. The mean follow up period was 6.7 months (range: 3-18). Outcome Measures: Pre and postoperative Cobb angle, apical vertebral rotation (AVR, Perdriolle method) and apical vertebral translation (AVT) were measured. Unpaired "t" test was used to compare the magnitude of correction in both groups.

Results: The mean corrections of Cobb angle, AVR and AVT, in group 1 were 61.1% (range: 48.5-83.9), 33.3% (range: 8.6-100) and 62.9% (range: 43.2-91.4), respectively. In Group 2, the corrections were: 57.4% (range: 21.4-81.7), 57.2% (range: 16.7-100) and 58.7% (range: 34-80.9). There was no statistically significant difference between the correction of Cobb angle or AVT in both groups (P = 0.479 and 0.443 respectively). However, the pedicle screws proved to be more effective at correcting the AVR (P = 0.017). At latest follow up, correction has been well maintained.

Conclusion: Pedicle screws can safely and effectively replace the pedicle hooks in the classical USS technique. They are more effective at correcting the rotational deformity, although do not provide a better correction of Cobb angle. These technical results now need to be correlated with relevant clinical outcomes.