Introduction Subdural collections, following brain surgeries in pediatrics, are common and unfortunately not always easily treated; especially in huge parenchymal tumors, intraventricular tumors and paraventricular tumors. Different approaches for prevention and treatment of theses subdural collections have been discussed by several studies, but till now no solid consensus has been reached. One of these approaches is to approximate incised cortical edges by suturing the pia, use of fibrin adhesive glue and subsequent Ringer inflation. The aim of our study is to avoid cortical mantle collapse and to prevent the development of progressive pressurizing subdural fluid collections. Patients and methods This study included 12 pediatric cases operated for large sized brain tumors between 2014 and 2019, in the department of Pediatric Neurosurgery at Alexandria University. All cases were operated via transcortical approach. Patients were followed prospectively for postoperative complications including postoperative subdural collections. In all patients, gel foam and fibrin glue on the cortical and ependymal edges, with suture approximation of the cortical edges and subsequent Ringer lactate inflation in the residual cavity were routinely done. Results With the consecutive follow-up images, six cases (50%) showed persistent subdural collection following tumor resection. Three cases had 5–6 mm asymptomatic subdural collection thickness that resolved within 3 to 6 months, and the rest three cases showed more than 7 mm thickness subdural collection. In these 3/12 (25%) cases patients had symptomatic and progressive increase in the subdural fluid collections. A subdural-peritoneal shunt was necessary only for 1 patient (8%). After finishing his adjuvant therapy, it was possible to remove the subdural-peritoneal shunt. While in the other 2 patients, the subdural collection was managed surgically with just a burr hole evacuation. The clinical manifestations resolved postoperatively but complete resolution of these 2 subdural collections occurred within 7 and 9 months. Conclusion The use of sutures and fibrin adhesive to seal surgical defects with inflation of the residual cavity with Ringer lactate solution might decrease the development of subdural fluid collections, through avoiding the cortical mantle collapse.

Background The aim of lumbopelvic fixation is to obtain a solid fusion across the lumbosacral junction. There are many indications for lumbopelvic fixation, namely, spinal deformity in cases requiring long segment fusion, pelvic obliquity, pseudarthrosis at the lumbosacral junction, infection or osteolytic tumors, and pathologic fractures. The classical iliac screws should be contained within the iliac bone but have some disadvantages: excessive soft tissue dissection needed for accurate insertion, screw prominence with patient discomfort, and usually, a side connector is needed to connect the iliac screws to the rest of the construct. Lumbopelvic fixation by insertion of S2 alar-iliac (S2AI) screws was recently described to overcome these disadvantages. In this study, the authors present the initial results for the evaluation of lumbopelvic fixation through the insertion of S2AI screws in 19 consecutive patients operated in the neurosurgery department at Alexandria University. Objective The aim of the study was to evaluate the efficacy and complications of lumbopelvic fixation through the use of S2 alar-iliac screws. Methods The authors conducted a retrospective cohort study of data collected from the database of patients who underwent lumbopelvic fixation through the insertion of S2AI screws from 2016 to 2019 at a single institution. Results There were 19 patients indicated for lumbopelvic fixation, operated by modern instrumentation systems using lumbar pedicle screws and S2 alar-iliac screws. There were 14 females and 5 males. The mean age at the time of the operation was 38.6 ± 19.4 years with a range from 11 to 65 years. There was a total of 37 S2AI screws, screw diameter was 7mm in all cases regardless of age, and the length of the screws ranged from 50 mm in a young female patient (11 years) to 90 mm in an old male patient (60 years). Two screws were inserted per patient except in one case with congenital scoliosis due to the bad bone quality and the multiple iatrogenic wrong paths. Postoperative VAS score for back pain was greatly improved in all patients after the first 6 months of follow-up from 8 ± 1.5 to 3.5 ± 1.2 (paired t-test = 11.182, P<0.001). All patients had a good spinal range of motion to maintain normal daily activities without any significant restrictions after the first 3 months of follow-up. Immediate postoperative radiological follow-up had revealed 2 cases of posterior pelvic breaches and one case with anterior pelvic breach but without clinical manifestations with no need for revision. Two cases of unilateral screw breakout were observed after the first 6 months of follow-up. Removal of screws after the first 6 months was done in one patient with spondylodiscitis due to the unresolved infection and screw pullout. Conclusion The insertion of S2AI screws is an effective technique for lumbopelvic fixation with a relatively low rate of complications. Pelvic breaches are the commonest complications encountered during the insertion of S2AI screws, although no significant clinical morbidities were reported.

Background Data: Sacral fractures constitute a major entity of pelvic fractures. 50% of these sacral fractures are not recognized on initial physical examination of the traumatized patients. The most important prognostic factor in management of sacral fractures is the presence or absence of neurological deficit. Some studies adopt the concern regarding fixation of sacral fractures in poly-traumatized patients to avoid systemic effects and complications of recumbency. Purpose: Evaluation of the efficacy and safety of the minimally invasive percutaneous ilio-sacral fixation technique in management of initial twenty cases of sacral fractures at department of Neurosurgery in Alexandria University. Study Design: Retrospective clinical case cohort study. Patients and Methods: Between March 2017 and January 2019; 20 patients were presented at Neurosurgery Department in Alexandria University hospitals with traumatic sacral fractures. They were 13 males and 7 females with the mean of 34 years (ranged from 18-55 years). Plain X ray of pelvis including anteroposterior, inlet and outlet views of pelvis, CT scan with 3D reconstructions were done. We used Dennis classification and Roy-Camille classification in our study. Stabilization of sacral fracture was done percutaneously using 7 mm cannulated partially threaded ilio-sacral screws. Clinical, neurologic and radiographic examinations were performed in the follow up period (6 months) to assess healing, evaluate clinical improvement and to detect any implant changes. Results: Total 39 percutaneous ilio-sacral screws were placed in 20 patients. Partially threaded cancellous 7.0-millimeter cannulated screws were used. Fifteen patients had unilateral double screws; one patient had unilateral triple screws; two patients had bilateral single screws for bilateral sacral fracture and two

Background Vertebral column resection (VCR) is a well-known technique used for correction of complex spinal deformities. VCR could be done through a posterior only approach (Pvcr), or a combined anteroposterior approach, with almost comparable results. Early studies of Pvcr have reported high rates of complications, while subsequent studies have reported a reasonable complication rate. In this study, the authors represent and evaluate the initial results of using the Pvcr technique to correct complex pediatric deformities. Objective To evaluate the safety and efficacy of performing Pvcr to correct complex pediatric deformities. Methods Retrospective cohort study of data was collected from the database of pediatric deformity patients who were operated for correction of their deformities using posterior instrumentation and Pvcr at a single institution from 2015 to 2019. Results Twenty-one pediatric patients with a mean age 15.2 ± 3.5 years were enrolled in this study. The mean follow-up period was 26.3 ± 3.1 months. The mean Cobb angle has been decreased significantly from 82.9 ± 23.9 degrees to 28.8 ± 14.2 immediately after correction (correction rate 66.9 ± 10.8%, p < 0.001) with slight increase to 30.2 ± 14.9 after 24 months of follow-up (correction loss 4.3 ± 3.1%). The mean kyphotic angle has decreased significantly from 74.1 ± 15.9 to 25.4 ± 4.5 immediately after correction (correction rate 65.4 ± 2.9%, p < 0.001) with slight increase to 26.7 ± 5.2 after 24 months of follow-up (correction loss 4.8 ± 3.5%). The mean estimated blood loss was 2816.7 ± 1441.5 ml. The mean operative time was 339 ± 84.3 min. Self-image domain (part of SRS-22 questionnaire) has significantly improved from a mean preoperative of 2.3 ± 0.5 to a mean postoperative of 3.9 ± 0.4 after 24 months of correction (p < 0.001). As regards complications, chest tubes were inserted in 17 cases (81%), one case (4.8%) had suffered from deep wound infection and temporary respiratory failure, while 3 cases (14.3%) had neurological deficits. Conclusion Posterior vertebral column resection is considered a highly effective release procedure that aids in the correction of almost any type of complex pediatric deformities with a correction rate reaching 66.9 ± 10.8%. However, Pvcr is a challenging procedure with high estimated blood loss and risk of neurological deficits, so it must be done only by experienced spine surgeons in the presence of good anesthesia and neuromonitoring teams.