Background: The placement of C1 lateral mass, C2 pedicle screw screws provide a useful alternative method to achieve atlantoaxial fixation. Aim of the work: This study aims at evaluation of Posterior Atlantoaxial fixation using Harms' technique in atlantoaxial subluxation regarding neck pain, fusion rates, neurological and radiographic outcomes. Patients and Methods: This method achieves immediate rigid stabilization of the atlantoaxial joint and obviates the need for halo vest immobilization. This technique may be used in certain cases as an alternative to occipitocervical fusion, and may also be used to increase construct stability when occipitocervical fixation is used. Results: We thus advocate that this procedure only be performed by surgeons who are highly experienced in the treatment of atlantoaxial instability, and who have an intimate understanding of the anatomy of this region. Further biomechanical analysis of this technique should be performed to quantify the strength of constructs employing C1 lateral mass, C2 pedicle screws as compared with other fixation methods. Conclusion: Further biomechanical analysis of this technique should be performed to quantify the strength of constructs employing C1 lateral mass, C2 pedicle screws as compared with other fixation methods.
Background: There is some degree of ventriculomegaly that occurs after myelomeningocele (MMC) repair. Aim of the study:This study aimed to identify the clinical predictors of the need for ventriculoperitoneal shunt placement in MMC patients to avoid unnecessary shunting with its complications.Methods: This retrospective cohort study included infants with lumbosacral myelomeningocele who were managed in the neurosurgical department in Ain Shams University Hospital from January 2016 to December 2018. The study was approved by the Research Ethics Committee of the Faculty of Medicine at our university. Informed consent was obtained as required.Results: Fifty patients met our selection criteria. Twenty-two patients (44%) needed shunts. The statistically significant clinical predictors of shunt placement in MMC patients were crossing the HC percentile for age, tense AF, sun setting of eyes, persistent vomiting, delayed or deteriorating developmental milestones, and CSF leakage from the MMC wound. Conclusion:Applying the statistically significant clinical predictors of shunt placement to decide shunt placement in MMC patients is of utmost importance to avoid unnecessary shunting.
Background Traumatic brain injury (TBI) is among the most important public health problems associated with high healthcare and social burden and significant mortality and morbidity. Overall low income countries have the highest TBI associated mortality and morbidity. Aim of the Work Some studies have demonstrated that intracranial pressure (ICP) monitoring reduces the mortality of traumatic brain injury (TBI). But other studies have shown that ICP monitoring is associated with increased mortality. Patients and Methods Systematic review of Published English literature from 2000 to 2017. Using appropriate combinations of MeSH terms and key words, including intracranial pressure, intracranial hypertension, ICP monitor, intracranial pressure monitoring, TBI traumatic brain injury, and craniocerebral trauma. Brain Trauma Foundation guidelines, mortality. We performed this relatively wide search to include the maximum number of relevant patients. Results In total, 2552 studies were identified and screened for retrieval using the strategy described above. After careening the title and abstract, 1968 studies were excluded and 554 were retrieved and subjected to detailed evaluations. Based on the inclusion and exclusion criteria, 527 of those studies were excluded, and thus 27 studies were included in the systematic review. All included studies were published, peer-previewed papers. Conclusion ICP monitoring may play a role in decreasing the rate of electrolyte disturbances, rate of renal failure, and increasing favorable functional outcome. However, there was no significant effect for reducing the risk of hospital mortality, lowering occurrence rate of pulmonary infection, use of mechanical ventilation and duration of hospital stays. RCTs with larger sample size are necessary to further support the current results.
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