Background: Several techniques have been described in literature for stabilization and fusion following anterior cervical corpectomy (ACC).

Objective: The aim of this retrospective study is to describe and evaluate the efficacy of a surgical technique using vertebral autograft bone fusion following anterior cervical corpectomy in posttraumatic fractures.

Methods: Between 2005and 2009 eight patients with posttraumatic lower cervical spine fractures were included in this retrospective study. Following adequate ACC a titanium mesh cage (Pyramesh) was filled with morselized bone material from the cervical corpectomy, was implanted and reinforced by an anterior cervical plate and screws. Pre and postoperative clinical assessment using the American Spinal Injury Association (ASIA) grading scale was performed as well as radiological assessment to assess fusion.

Results: Male to female ratio was 7:1 with average age 29.5 years. Cervical vertebra 5 was the most common affected (62.5%). Average operative time was 110 minutes. Postoperative temporary dysphagia was encountered in 35.5%. Clinical improvement was present in 62.5%. Bone fusion was achieved in all cases at one and half year follows up.

Conclusion: This technique demonstrates that vertebral autograft embedded in a Titanium mesh cage reinforced by anterior plating is reliable and effective in achieving fusion and stabilization. The complications associated with other donor sites (iliac crest or fibula) autograft could be avoided with less operative time.

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Background: Irreducible anterior atlantoaxial dislocation is often treated by trans-oral decompression followed by posterior internal fixation. This approach has resulted in many morbidities and mortalities. In the present study, the author presents his experience in an entirely posterior approach where posterior decompression and occipitocervical fusion are made.

Methods: Eight patients suffering from old neglected atlantoaxial fracture with anterior dislocation were treated. The duration of the condition varied between 6 months and 20 years. All of them presented with myelopathy (average grade IV motor power). They were operated upon by posterior decompression and occipitocervical fusion. No attempt was made to reduce the dislocation.

Results: All patients had smooth post-operative periods. Their weakness improved and continued to improve with physiotherapy. The average improvement was one grade of the motor scale.
Conclusions: Posterior decompression and occipitocervical fusion is a safe and effective approach in the management of irreducible atlantoaxial dislocation. This procedure is probably as effective as and much safer than the commonly practiced combined transoral odontoidectomy and posterior fixation.

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Methodology: This retrospective study includes nine cases with L 1 burst fracture operated upon by posterior short segment pedicle screw fixation, between 2005 and 2009. Patients were assessed clinically using the Frankel classification. Kyphosis was measured using the Cobb s method.

Results: Male to female ratio was 8:1 with an average age of 35 years. All patients were post traumatic, MVA in 55.55% and fall from a height in 44.44%. Type B fracture was encountered in 88.8% of cases according to Denis classification. The average follow up period was 24 months. A mean of 7.5 degree correction of kyphosis was achieved. The post operative vertebral height ratio became 0.88 compared to 0.71 pre operative. Clinically,88.8% showed improvement by at least one grade according to Frankel classification.

Conclusion: The posterior short segment pedicle screw fixation is safe and effective methods in treating L1 burst fractures. It corrects angular deformity, restores body height, stabilizes the spinal column and improves the clinical condition of the patients.

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Objective: To explore a more effective and less invasive minimally destructive decompression technique supplemented by the enzymatic avoidance of fibrous tissue deposition without the need for any instrumental fixation or fusion as a standard procedure for lumbar spinal canal stenosis.

Summary of Background Data: The out of vogue wide laminectomy, that was the traditional surgical decompression for lumbar spinal canal stenosis showed unacceptable rate of complications. In the last few decades; it gradually became vivid that the minimal destructive techniques are more suitable for the geriatric age group. However, as these maneuvers are considered operatively conservative techniques, which is a welcomed attitude to avoid the hypermobility-dislocation complications, yet efforts that seek the avoidance of the deposition of excessive fibrous tissue in this constricted and limited field are logic. We present our novel maneuver of conservative rectangular laminotomy and flavectomy that respect and preserve the posterior elements followed by post-operative IM injection regimen of the proteolytic and anti-protienaceous edema (the enzyme alpha chymotrypsin) that proved successful with a low incidence of complications. Addition of instrumentation may increase the complication rate, also compared to the efficiency, the higher costs is controversial. Thus according to our data minimal invasion without stabilization followed by the very beneficial proteoytic and anti proteinaceous edema drug alpha chymotrypsin injections is recommended.

Methods: This prospective study included 51 consecutive patients, sequentially divided into 2 groups, (group A) underwent the rectangular laminotomy technique with postoperative antiedematous alpha chymotrypsin IM injections for two weeks and (group B) that underwent the same decompressive laminotomy without the enzymatic injections.

Results: The evaluation of the back pain, leg pain, walking tolerance, and neurologic recovery were performed before surgery and after surgery. In group A, at the final evaluation, the overall results were good to excellent in 88% of the patients, fair in 12%, and poor in 0%. In group B, at the final evaluation, the overall results were good to excellent in 61.5% of the patients, fair in 30%, and poor in 7.7%.

Conclusion: Degenerative lumbar spinal canal stenosis can be decompressed adequately with preserving the posterior elements. The rectangular laminoforaminotomy with the proteolytic and antiedematous enzyme alpha chymotrypsin IM twice/ day for a week then once daily for another week as to digest tissue debris, exudates and proteinaceous edema that later invite fibrous tissue deposition in the area, obtained satisfactory long-term outcome with few complications and low cost. It can be a standard procedure for the surgical treatment of the lumbar degenerative spinal stenosis.

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Summary and Background: The popular two cervical laminoplasties for the nowadays becoming common in elderly people cervical myelopathy secondary to cervical spinal canal stenosis are open door laminoplasty and double doors laminoplasty. They are plagued with many drawbacks such as around 50% diminution in the range of cervical movements, 25% occurrence of kyphotic deformity, laminar fusions, from 10% to 50% chronic axial neck pain and nuchal musculature atrophy. A more physiological modification of this very beneficial operation is badly needed. We presented our novel reconstructive cervical laminoplasty with the preserved spinous processes row as an intervening bone grafts to avoid such drawbacks.

Methods: This prospective preliminary study included 14 patients who underwent the novel reconstructive cervical laminoplasty with the preserved fixed spinous processes row as an intervening bone graft operation for their cervical myelopathy.

Results: The novel operation is proved to be easier, more physiological and succeeded to avoid to a great extent the aforementioned drawbacks of the two popular cervical laminoplasties; only about 30% diminution of cervical movements occurred, no kyphotic deformities, post-operative axial neck pain was moderate and occurred in only 21% of the patients and the post operative nuchal musculature atrophy was avoided.

Conclusion: Cervical myelopathy secondary to cervical spinal canal stenosis can be managed adequately with our novel cervical reconstructive laminoplasty with the preserved fixed spinous processes as intervening bone grafts. This technique obtained satisfactory outcomes and avoided the drawbacks of the popular laminoplasty operations. It can be a standard procedure for the surgical treatment of this nowadays becoming common disease.

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Methods: This is a prospective study of 14 patients harboring vestibular schwannomas who were operated upon through retrosigmoid approach. In all patients intraoperative facial nerve stimulation was used to detect the site of facial nerve.

Results: Eight patients were females and 6 were males. The youngest was 18 years-old and the oldest was 63 years-old .Three patients had facial nerve affection preoperative G II to G III. Tumor size ranged from 3.8 cm to 6 cm. At the end of the 3rd postoperative day 8 patients had facial nerve affection ranging from G IV to G VI (57%). Facial nerve was preserved anatomically in 12 patients (86%).

Conclusion: Intraoperative facial nerve stimulation is advisable during all surgeries for vestibular schwannomas because it helps in early detection of facial nerve place intraoperative and consequently its preservation.

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Methods: This is a prospective study of 86 patients harboring pituitary adenoma. All patients were operated upon using sublabial transseptal transsphenoid approach. The aim was total removal of the tumor .Rigid 30 degrees angle endoscope was used in 16 patients at the end of tumor removal to detect any tumor residual. Follow up period ranged from 6 months to 6 years with special attention to the nasal complaints.

Results:Eighty six patients were included in this study, 53 females and 33 males. The mean age was 41.5 years. In 34 patients (40%) GH secreting adenomas were detected, Prolactinomas in 15 patients (17%), nonfunctioning adenomas in 24 patients (28%) and ACTH secreting adenomas in 13 patients (15%).Main presenting symptoms included visual deterioration in 53% of cases, headache in 58% and acromegaly in 36%.Sixty one patients harbored macroadenomas and 25 harbored microadenomas. Gross total removal was achieved in 72 patients (84%).All patients suffered from nasal obstruction and bilateral anosmia postoperative that resolved completely in all patients within 2 months after surgery. No other nasal complications were detected. Other complications included CSF rhinorrea in 16 patients (19%), electrolyte imbalance in 9%, worsening of vision in 4%, meningitis in 5% and hypopituitarism in 5%.

Conclusion: Sublabial transseptal transsphenoid approach to pituitary adenomas is a safe and effective approach and has minimal complications . The main advantage of this approach is well orientation of the midline throughout the procedure.

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Objective: The aim of this study was to review the surgical indications in a series of patients operated upon for prolactinomas, and to show postoperative biochemical cure rate and need for postoperative adjuvant therapy.

Patients and Methods: Data of 25 patients operated upon for prolactinomas have been retrospectively reviewed including clinical presentation, previous treatment, preoperative and postoperative prolactin levels, preoperative and postoperative magnetic resonance imaging (MRI), and indication of surgery in each patient. Clinical outcome, biochemical cure, and postoperative adjuvant therapy were reviewed.

Results: The commonest indications of surgery were failure of medical treatment to achieve biochemical cure and/or tumor control and marked visual affection. Other indications included intolerance to medical treatment, pituitary apoplexy, microprolactinomas with moderately elevated prolactin, and patient refusing long-term medical treatment. Biochemical cure was achieved in 10 patients, and was not achieved in any patient with invasive adenoma or elevated serum prolactin above 1000 ng/ml. Medical treatment was given postoperatively to all non-cured patients, in addition to radiosurgery in one patient.

Conclusion: Surgery still has an important role in patients with failure or intolerance to medical treatment. Patients with marked visual affection, pituitary apoplexy, and microadenomas with moderately elevated prolactin are possible candidates for surgery. Surgery can be performed as a part of multimodal treatment in patients with giant and/or invasive adenomas or serum prolactin above 1000 ng/ml.

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Methods: This retrospective study includes 14 patients with abdominal complications secondary to VP or LP shunts for CSF diversion who were laparoscopically treated in the department of pediatric surgery, Cairo University Aboul Rish Hospital, between 2008 and 2010. Their ages ranged between 7 months and 16 years (mean age 4.7 years old), male to female ratio 9:5. Eleven patients had VP shunts and 3 had LP shunts.

Results: Peritoneal segment complications included: shunt fracture or disconnection and intraperitoneal catheter migration in 37% (5/14), abdominal pseudocysts in 21% (3/14), CSF ascitis in 14% (2/14), scrotal position of tip in 7% (1/14) and infections 21% (3/14) such as abscesses in 2 and peritonitis in one due to perforated viscus in one and of the anterior abdominal wall in the another two. The role of the laparoscope was: retrieval of the migrated disconnected shunt, evacuation, debridement, lavage and drainage for pseudocysts, abscess and peritonitis and repositioning of peritoneal segment tip and assessment of function.

Conclusion: Abdominal complication following CSF shunts can be successfully, sufficiently and safely managed laparoscopically.

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Method: Between January 2003 and December 2008, 18 patients with lesions in the sellar region or the anterior corridor leading to it were operated upon via the same approach. There were 10 males and 8 females. The age ranged between 11 months and 15 years (mean 7.9 years). The pathologies were craniopharyngiomas in 6 cases, hypothalamic and chiasmal pilocytic astrocytoma in 7 and 5 miscellaneous cases including 2 pituitary adenomas, 1 extradural hematomas, hypothalamic hamartoma and 1 arachnoid cyst in the retrosellar and pre-pontine area. Surgery was performed from the right side in 15 cases and from the left in 3 cases.

Results: Total resection was achieved in 9 cases (50%), Subtotal resection in 4 cases (22%), and partial in 5 cases (28%).). Complications related to the approach like CSF rhinorrhea, supra-orbital hyposthesia and loss of upward elevation of the eyebrow were temporary. There were no mortality in this study and no significant added morbidities related to the approach. The approach gathers the advantages of the small cosmetic eye brow incision and the skull base trajectory thus reducing brain retraction and achieving the desired exposure with good outcome.

Conclusion: The MFOZ craniotomy using an eyebrow incision in pediatric patients is safe, effective, and both suitable and convenient for treating lesions especially at the sellar region.

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Purpose: To assess the clinical efficacy of percutaneous radiofrequency denervation of the lumbar zygapophysial (facet) joints in reducing pain, functional disability, and physical impairment in patients with back pain originating from the lumbar zygapophysial joints.

Background: Lumbar zygapophysial joint arthropathy is a challenging condition affecting up to 15% of patients with chronic low back pain. Despite previous reports of a "facet syndrome", the existing literature does not support the use of historic or physical examination findings to diagnose lumbar zygapophysial joint pain. A treatment option is percutaneous radiofrequency denervation of the lumbar zygapophysial joints which appears to be an emerging technology, with substantial variations in use.

Methods: Over a period of two years, forty-five patients underwent 80? C radiofrequency lesion of the dorsal ramus of the segmental nerve roots L3, L4, and L5 for chronic low back pain. Eligible patients underwent a standardized diagnostic work-up, which included physical examination, review of imaging studies, the use of a visual analog scale (VAS), and diagnostic blockades. Pain relief was assessed in short-term follow up (on the third day, and at 3 months) and on long-term follow up at (6 months and 12 months) post-treatment, using the visual analog scale and the SF-36 Health Survey.

Results: There were 26 women and 19 men included in the study. The mean age was 64.5 years (range, 38~83 years). Radiofrequency neurotomy denervated three segments and a bilateral lesion in all patients. The visual analogue scale (VAS) scores on the third day (mean VAS score: 1.7) and 3 months (mean VAS score: 2.9) after treatment decreased significantly when compared with the pre-treatment scores (mean VAS score: 8.1). However, the values of the VAS scores after 6 months and 12 months were slightly increased as compared to the VAS scores measured at the beginning of the study (mean VAS score: 3.8 and 4.8 respectively). Only 2 patients got a transient pain.

Conclusions: We suggest that radiofrequency neurotomy offers an effective palliative management of lumbar facet pain. However, there is limited evidence that radiofrequency neurotomy offers short-term relief for chronic low back pain. Further high-quality randomized controlled trials are needed with larger patient numbers and more data on the long-term effects, for which current evidence is inconclusive.

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Objective: The purpose of this prospective study was to evaluate the early management versus delayed management of these combined craniofacial fractures.

Methods: Fifty-five patients (46 males and 9 females) ranging in age from 5 to 62 years with combined craniofacial fractures were included. All clinical records, investigations and treatment charts were reviewed and data regarding age, gender, aetiology, pattern of injuries, anatomic site and pattern of facial fractures, associated cranial injuries and systemic injuries, treatment details and complications were analyzed. Patients with head injuries were categorized according to Glasgow coma scale into three grades: mild, moderate, or severe categories. Fractures of the facial skeleton based on facial bone imaging were grouped; Frontal, Fronto zygomatic, Frontal maxillary, Frontal nasoethmoid and panfacial. Systemic injuries were grouped into following categories as polytrauma, Limbs fractures, thoracic and/or abdominal lesion and eye injury. Conservative treatment was indicated in 7 patients while the remaining 48 patients underwent surgical intervention and classified into two groups: group 1:35 patients received early (less than two weeks) one-step surgical treatment of their fractures and group II: 13 patients received late surgery (more than 2 weeks after the trauma).

Results: Majority of the patients were in the 2nd to 4th decade (79%) with a male to female ratio of 5:1. Road traffic accidents were the common cause of craniofacial trauma (73.6%) followed by fall from height (15%). Majority of patients had mild head injury and managed conservatively in present series. Coronal approach was performed in 12 patients (25%), translesional in 35 (73%), and superciliary in 1 (2%). Regarding the intracranial procedures: elevation of depressed fractures with dural repair was needed in 39 patients; primary dural closure was done in 31 patients, while 8 patients needed pericranial graft. Evacuation of intracranial hematomas was performed in 8 patients. Maxillofacial procedures consisted of exenteration of the sinus in 33 patients, cranialization of the sinuses in 5 patients. The nasofrontal duct was identified and packed with muscle grafts in 36 patients. In 9 patients there was a large bone defect which repaired by bone grafts. In 39 patients bone fragments and/or bone grafts were fixed by miniplates only or by miniplates and wires.

Conclusion: early single-stage repair of complex craniofacial injuries can be performed with an acceptable rate of morbidity and mortality. Many advantages are reported for the early surgical repair such as prevention of infection, better cosmetic and functional results and reduce hospital stay.

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Patients and Method: It is a retrospective study done in Cairo hospitals ,Egypt ,including 63 patients over 3 years, from march 2006 to march 2009.in 17 patients the initial indication for surgery was lumber disc prolapsed ,and in 33 it was lumber canal stenosis ,and epidural fibrosis in 13patients ,with follow-up for one year postoperatively.

Results: Spinal or lateral recess stenosis was 33 case,epidural scar 13 cases and Recurrent disc prolapsed 17 cases, pain score on pain facial scale was from 6 to 10 with average 8.Causes of FBSS are Recurrent or persistent disc prolapsed , epidural fibrosis ,lateral spinal stenosis ,and all cases had the leg pain more than back pain.

Discussion: Metehan etal found in his series the success rate of all failed back surgery syndrome cases is found as; 37.3% for the patients with epidural fibrosis and 75.9% is reported for the patients without fibrosis. The statistical comparison is found as meaningful of these success rates.(p<0.05).

Conclusion: Secondary decompresive operation is a useful one if sciatic pain due to nerve compression by disc or bone but not to fibrosis.the best way to avoid an unsuccessful spine surgery is to stick to operations that have a high degree of success and to make sure that an anatomic lesion that is amenable to surgical correction is identified preoperatively.

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Patients and Methods: It is a prospective study including 22 patients went for selective tibial neurectomy, from march 2005 to march 2010 in Cairo hospitals ,Egypt with follow up of the patient every 3 months for one year Investigations: preoperative C.T or MRI to avoid hydrocephalus , hemorrhage ,or other cranial congenital nomalies.Routine blood lab to avoid blood and coagulability disease.Pre and post operative assessment: by Ashworth scale , gait improvement and parents satisfaction regarding childcare (excellent, good , fair , none).

Results: 22 patients with 9 male and 13 females ,age from 5 to 10 years with mean 7.5 years ,preoperatively Ashworth scale ranged from 3 to 4 with mean 3.5 and postoperatively it ranged from 1 to 2 with mean 1.5, Postoperative complications: one case(4.5%) with wound infection and cured by antibiotic therapy ,2 (9%)cases of post operative haematoma and resolved spontaneously after 2 weeks,2(9%) cases with dysesthetic pain controlled by carbamazepine and pregabalin tablets.

Conclusion: Selective tibial neurectomy has a several advantages as maintaining long term effect in flexed knee and spastic leg muscles and improvement of the patient walking ability with low incidence of complications compared to other local management procedures.

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Objective: There are limited studies about ICH in children. In this study, we analyze the etiology, clinical features, management options and outcome assessment in this population.

Methods: All patients of intracerebral hemorrhage aged 18 years and below admitted at the neurosurgery department; Alexandria University Main Hospital and Medical Research Institute over a period of one year (June 2008-May 2009) were subjected to clinical, laboratory and radiological investigations and the cause of hemorrhage was determined.

Results: Thirty patients with ICH were included in this study. Age of patients ranged from 1 month to 17.5 years with higher predilection in males. Presenting features were symptoms of raised intracranial pressure (60.0%), deterioration in sensorium (46.6%), limb weakness (36.6%) and seizures (30.0%). Trauma was the most common cause of ICH and was found in 13 patients (43.3%), followed by bleeding diathesis in 9 patients (30%), (AVM) in 5 patients (16.6%), intracranial tumor in two patients and aneurysm in one patient. The nine patients of bleeding diathesis were; three cases of idiopathic thrombocytopenic purpura (ITP), three cases with hemophilia, two cases with acute lymphoblastic leukemia (ALL)and a case of sickle cell anemia (SCA). Diagnosis was confirmed by radiological studies and laboratory investigations including; complete blood picture, bone marrow aspiration and coagulation profile (PT, PTT, and factor assay). Treatment modalities consisted of: hematoma evacuation, excision of AVM, emobilization, aneurysm clipping, tumor excision, and conservative management. Of the 30 cases, 11 patients were conservatively treated and 19 patients were surgically treated. The outcome showed: good recovery in 14(47%), fair recovery in 7(23%), poor recovery in 7(23%), and death in 2 patients (7%).

Conclusions: Trauma is an important cause of ICH in children, alongside bleeding diathesis and AVM which are the next leading causes. The initial neurological status of the patients beside the size, location and underlying pathophysiology of the hematoma are the most determinants of the patients' outcome. Intracerebral hemorrhage due to bleeding diathesis was generally associated with better outcome.

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