Cranioplasty is a routine procedure in neurosurgery. However, it has a high postoperative complication rate up to 40%. The lack of good prospective studies and the small number of patients who receive artificial substitutes make it difficult to choose between different materials and the decision is mostly based on subjective or economic reasons. The main goal of this study was to compare the most common complications related to the implant within the first year after implantation. Methods: This prospective randomized clinical study has been carried out on 32 patients with cranial defects of different etiologies, sites and sizes which have been operated in Assiut

Introduction: Cervical radiculopathy is caused by either cervical disc herniation or bone spurs due to cervical spine degeneration. It is common in middle aged and elderly patients. Those patients who are refractory to conservative treatment are candidates for surgical management. The surgical approaches for cervical radiculopathy are either anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF). In spite of many reports on ACDF and PCF, only a few studies directly compare the outcomes of both techniques. Purpose: To compare anterior cervical discectomy and fusion (ACDF) with posterior cervical foraminotomy (PCF) for the treatment of cervical radiculopathy, regarding the surgical, clinical and radiological outcomes. Patient and methods: This is a prospective randomized controlled clinical study carried on 44 patients with unilateral cervical radiculopathy. They are divided into 2 groups; group (A) included 23 patients who underwent ACDF and group (B) included 21 patients who underwent PCF, with 1 year follow up. The patient age, sex, clinical manifestations, surgical outcomes as number of cervical level, operative time, blood loss, complications and length of hospital stay were recorded. Visual analogus scale (VAS) and neck disability index (NDI) were used for evaluation of clinical outcomes. Postoperative imaging was done after 1 year to detect instability or adjacent level degeneration. Chi-square and unpaired T-test were used to compare the mean values of both groups. Results: The mean age was nearly 45 years for both groups. C5-6 ACDF was the most common level in group (A), while C6-7 PCF was the most frequent operated level in group (B). PCF group had less operative time, blood loss and length of hospital stay than ACDF group. Clinical improvement of the mean values of VAS and NDI were more pro-

Introduction: The majority of series considered the conventional open discectomy as the gold standard for the treatment of lumbar disc prolapse. Despite of the popularity of the lumbar endoscopic discectomy nowadays, many neurosurgeons still prefer conventional open discectomy. Purpose: Our study has been designed to compare between percutaneous endoscopic lumbar discectomy and conventional open discectomy; regarding surgical results, complications, clinical and functional outcomes. Patients and Methods: This study is a clinical prospective randomized controlled trial conducted upon 30 patients suffering from prolapsed lumbar disc, from December 2016 to May 2018. Those patients were divided randomly into 2 groups, 15 patients each. One group treated by percutaneous endoscopic interlaminar lumbar discectomy (PELD) and the other group treated by conventional open discectomy (COD). Operative time, wound size, Intraoperative blood loss, Intraoperative complications, postoperative hospital stay, Postoperative complication and the results of visual analogue score (VAS) and modified MacNab's criteria were assessed. Results: This study included 30 patients (18 males and 12 females). The mean age was about 35 years. Although, there was postoperative improvement of the VAS and MacNab's criteria in the two groups, there was no statistically significant difference between the preoperative and postoperative VAS of low back pain and radicular pain for the two groups in the follow up period. Conclusion: Both techniques give good results for patients; each technique has some advantages over the other.

Introduction: The etiology of recurrence of chronic subdural hematoma (CSDH) after surgical evacuation has not been completely understood until now, but several risk factors for recurrence have been reported. Meanwhile, the definitive risk factors have not been defined until now. Aim of Study: Analyze the potential risk factors, and emphasize preoperative, operative and post-operative ones for CSDH recurrence. Patients and Methods: This study is a prospective randomized clinical trial study including 82 patients with symptomatizing CSDH who underwent burr holes procedure and irrigation with closed system drainage for CSDH at Neurosurgical Department-Assuit University Hospital from July 2016 to July 2018. The possible factor studied for recurrence included age, hypertension, diabetes mellitus, liver diseases, Hemoglobin (Hb) level, prothrombin concentration and time (PC and PT), hematoma thickness and internal architecture, number of burr holes and position of drain, duration of drainage, amount of drainage and presence of postoperative residual hematoma on follow up CT brain. Multiple logistic regression analysis is used to assess the predictors of recurrence. Results: This study included 70 males and 12 females. The mean age was 58.9 years (range 34 -93 years). 6 patients presented with recurrent CSDH. Age above 60 years, Hypertension, Diabetes mellitus (DM), prolong PT, separated and trabecular internal architecture of hematoma, and the thickness of hematoma more than 20 mm in pre-operative CT and postoperative residual hematoma were statistically significant factors for recurrence of CSDH. Conclusion: This information might be helpful in detecting patients with possible high incidence of recurrence and directing for close follow ups and acts that may reduce the incidence of recurrence.

Background: Endoscopic transnasal skull base surgery had started long time ago in different centers around the world for excision of skull base lesions with good results and more cost effectiveness. The aim of this study is to discuss our early results in endoscopic skull base surgery and the development of the learning curve. Patients and Methods: We analyzed our experience regarding 25 patients presented to us in Neurosurgery Department,

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Posterior mediastinal dumb-bell tumours are neurogenic tumours that extend from the mediastinum to the intraspinal canal. They represent a surgical challenge because they may be resected using a staged or a single-stage approach. Until recently, a classic posterolateral thoracotomy was the gold standard for surgical resection for the intrathoracic segment. In the meantime, video-assisted thoracoscopic surgery has gained great acceptance among most thoracic surgeons because of the decreased surgical trauma, less operative blood loss and fewer postoperative complications and the shorter hospital stays. Proper selection of cases for thoracoscopic excision is crucial for ensuring good surgical outcomes. Factors such as tumour size, location and presence or absence of features suggesting malignancy should be considered. This procedure can offer great help in different case scenarios involving posterior mediastinal dumb-bell tumours. For giant tumours that will eventually need a thoracotomy, video-assisted thoracoscopic surgery helps the surgical team to choose an optimal site for a tailored thoracotomy incision and rule out any metastatic pleura seedings. In cases of small intrathoracic segments of dumb-bell tumours (≤ 6–8 cm) that require combined spinal and thoracic procedures in a single-stage approach, a combined posterior and video-assisted thoracoscopic surgical approach can be implemented for total resection of the tumour.