Background: Surgery of chronic subdural hematoma (CSDH) is a common practice of neurosurgeons. CSDH is considered a pathology of the elderly and usually many co-morbidities are present. CSDH carries high risk of morta...Background: Surgery of chronic subdural hematoma (CSDH) is a common practice of neurosurgeons. CSDH is considered a pathology of the elderly and usually many co-morbidities are present. CSDH carries high risk of mortality if not treated or not treated well. So, the minimal, safe and adequate surgical intervention is the bases to choose specific surgical maneuver. Aim of the Study: The efficacy of a single burr in evacuation and treatment of chronic subdural hematoma. Methods: This study was held in Assiut university hospitals, neurosurgical department. It is a prospective randomized controlled study. 113 patients were enrolled in this study in the period between March 2018 and June 2019. We included all cases of chronic subdural hematoma (CSDH) and subacute subdural hematoma that were evacuated with single burr hole. Hematomas either, unilateral or bilateral were included. Septated hematomas were excluded. Patients’ clinical characteristics as age, sex, clinical presentation, co-morbidities and patients outcome were recorded. Postoperative status as regards improvement of the neurological status, complications and recurrence of hematoma were recorded. Results: We had 113 patients operated via properly situated single burr hole in our study. 113 patients were included in this study, 79 males (69.9%) and 34 females (30.1%). Age of the patients ranges between 27 years old and 90 years old. Postoperative follow up was evaluated according to Glasgow outcome score (GOS). We had 98 patients with good recovery, 4 patients with moderate disability, 6 patients with severe disability and 5 patients died. Complications were in form of 3 patients with residual hematoma, 2 patients with tension pneumocephalus, 7 patients developed postoperative seizure, 5 cases developed cortical/parenchymal hematoma and 9 cases developed hematoma recurrence. Conclusion: Single, properly situated burr hole with previously described characters is an effective treatment option in cases of CSDH. It helps adequate, effective and safe removal of the pathology with limited maneuver.展开更多
Introduction: Chiari malformation Type I (CM-I) is typically defined as descent of the caudal tip of cerebellar tonsils at least 5 mm below the foramen magnum. The incidence of the malformation is not exactly known. T...Introduction: Chiari malformation Type I (CM-I) is typically defined as descent of the caudal tip of cerebellar tonsils at least 5 mm below the foramen magnum. The incidence of the malformation is not exactly known. Treatment of Chiari I malformation is debatable. Some advocate posterior fossa decompression (PFD) with duroplasty and others advocate posterior fossa decompression only without duroplasty. Aim of the Study: To compare the outcomes of patients who undergoing PFD with duroplasty and PFD without duroplasty, in Chiari I malformation. Patients and Methods: In the period between “January 2015-June 2016”, a prospective study was conducted involving 20 patients complaining of headache, motor and/or sensory affection secondary to Chiari I malformation. These patients were randomly divided into 2 groups. The first one had PFD with duroplasty and the other will have PFD without duroplasty. All patients had chiari one malformation in form of tonsillar herniation and cervical or cervico-dorsal syrinx. The average follow-up period was 9 months. Results: Over 90% of patients had a good clinical outcome, with improvement or resolution of their symptoms at last follow-up. There were no major complications. The mean length of hospital stay was 2.0 days. There was no perioperative death or neurological deterioration. The use of duroplasty was significantly associated with presence of complications and longer duration of hospital stay. Conclusion: PFD without duroplasty in cases of chiari I malformation carries a good results as well as PFD with duroplasty with lower risk of complications.展开更多
Introduction: Meningiomas are the most common type of extra-axial neoplasm. Peritumoral brain edema (PTBE) can be seen around meningiomas while it may be absent in others. Despite that Ki67 proliferative index has bee...Introduction: Meningiomas are the most common type of extra-axial neoplasm. Peritumoral brain edema (PTBE) can be seen around meningiomas while it may be absent in others. Despite that Ki67 proliferative index has been previously correlated with meningioma grades, no definite relationship has been established in relation to PTBE in meningioma patients. Objective: Correlate the peritumoral brain edema with the Ki67 proliferative index of meningiomas. Patients & Methods: Aclinical prospective study was conducted on 56 patients (47 women, 9 men;mean age 50.89 ± 12.55 years) diagnosed with meningiomas. All patients were evaluated regarding the presence of brain edema surrounding the lesion in pre-operative neuroimaging using T2W and FLAIR MR images. Immunohistochemical staining of Ki67 index (representing proliferative activity) was done. Correlation between presence of PTBE and Ki67 index values was evaluated. Results: PTBE was found in nearly half of the patients (48.2%), while the remaining (51.8%) of patients did not exhibit PTBE in their pre-operative neuroimaging. The mean value of Ki67 index in meningioma patients with PTBE was 4.83% compared to a value of 1.83% in patients without PTBE, P value = 0.014. Conclusion: High Ki67 indices are evident in meningiomas with surrounding peritumoral brain edema (PTBE).展开更多
文摘Background: Surgery of chronic subdural hematoma (CSDH) is a common practice of neurosurgeons. CSDH is considered a pathology of the elderly and usually many co-morbidities are present. CSDH carries high risk of mortality if not treated or not treated well. So, the minimal, safe and adequate surgical intervention is the bases to choose specific surgical maneuver. Aim of the Study: The efficacy of a single burr in evacuation and treatment of chronic subdural hematoma. Methods: This study was held in Assiut university hospitals, neurosurgical department. It is a prospective randomized controlled study. 113 patients were enrolled in this study in the period between March 2018 and June 2019. We included all cases of chronic subdural hematoma (CSDH) and subacute subdural hematoma that were evacuated with single burr hole. Hematomas either, unilateral or bilateral were included. Septated hematomas were excluded. Patients’ clinical characteristics as age, sex, clinical presentation, co-morbidities and patients outcome were recorded. Postoperative status as regards improvement of the neurological status, complications and recurrence of hematoma were recorded. Results: We had 113 patients operated via properly situated single burr hole in our study. 113 patients were included in this study, 79 males (69.9%) and 34 females (30.1%). Age of the patients ranges between 27 years old and 90 years old. Postoperative follow up was evaluated according to Glasgow outcome score (GOS). We had 98 patients with good recovery, 4 patients with moderate disability, 6 patients with severe disability and 5 patients died. Complications were in form of 3 patients with residual hematoma, 2 patients with tension pneumocephalus, 7 patients developed postoperative seizure, 5 cases developed cortical/parenchymal hematoma and 9 cases developed hematoma recurrence. Conclusion: Single, properly situated burr hole with previously described characters is an effective treatment option in cases of CSDH. It helps adequate, effective and safe removal of the pathology with limited maneuver.
文摘Introduction: Chiari malformation Type I (CM-I) is typically defined as descent of the caudal tip of cerebellar tonsils at least 5 mm below the foramen magnum. The incidence of the malformation is not exactly known. Treatment of Chiari I malformation is debatable. Some advocate posterior fossa decompression (PFD) with duroplasty and others advocate posterior fossa decompression only without duroplasty. Aim of the Study: To compare the outcomes of patients who undergoing PFD with duroplasty and PFD without duroplasty, in Chiari I malformation. Patients and Methods: In the period between “January 2015-June 2016”, a prospective study was conducted involving 20 patients complaining of headache, motor and/or sensory affection secondary to Chiari I malformation. These patients were randomly divided into 2 groups. The first one had PFD with duroplasty and the other will have PFD without duroplasty. All patients had chiari one malformation in form of tonsillar herniation and cervical or cervico-dorsal syrinx. The average follow-up period was 9 months. Results: Over 90% of patients had a good clinical outcome, with improvement or resolution of their symptoms at last follow-up. There were no major complications. The mean length of hospital stay was 2.0 days. There was no perioperative death or neurological deterioration. The use of duroplasty was significantly associated with presence of complications and longer duration of hospital stay. Conclusion: PFD without duroplasty in cases of chiari I malformation carries a good results as well as PFD with duroplasty with lower risk of complications.
文摘Introduction: Meningiomas are the most common type of extra-axial neoplasm. Peritumoral brain edema (PTBE) can be seen around meningiomas while it may be absent in others. Despite that Ki67 proliferative index has been previously correlated with meningioma grades, no definite relationship has been established in relation to PTBE in meningioma patients. Objective: Correlate the peritumoral brain edema with the Ki67 proliferative index of meningiomas. Patients & Methods: Aclinical prospective study was conducted on 56 patients (47 women, 9 men;mean age 50.89 ± 12.55 years) diagnosed with meningiomas. All patients were evaluated regarding the presence of brain edema surrounding the lesion in pre-operative neuroimaging using T2W and FLAIR MR images. Immunohistochemical staining of Ki67 index (representing proliferative activity) was done. Correlation between presence of PTBE and Ki67 index values was evaluated. Results: PTBE was found in nearly half of the patients (48.2%), while the remaining (51.8%) of patients did not exhibit PTBE in their pre-operative neuroimaging. The mean value of Ki67 index in meningioma patients with PTBE was 4.83% compared to a value of 1.83% in patients without PTBE, P value = 0.014. Conclusion: High Ki67 indices are evident in meningiomas with surrounding peritumoral brain edema (PTBE).
