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Objectives Ventriculoperitoneal (VP) shunting is commonly used to treat pediatric hydrocephalus, but failure rates are high. VP shunt failure in children is mostly caused by infection and/or proximal/distal shunt obstruction. However, to our knowledge, no previous reviews have discussed this topic using only clinical studies when age-related data could be obtained. This systematic review aimed at reevaluating what is already known as the most common causes of shunt failure and to determine the incidence and causes of VP shunt failure during the first 2 years of life as a step to establish solid evidence-based guidelines to avoid VP shunt failure in infants. Methods We performed a search using the search terms “Cerebrospinal Fluid Shunts” (Medical Subject Headings [MeSH]) AND failure [All Fields] AND (“humans” [MeSH] AND English [lang] AND “infant” [MeSH]). Only articles that specifically discussed VP shunt complications in children < 2 years were included. Results We found that the most common causes of VP shunt failure in children < 2 years were shunt obstruction and infection, both observed in a range. Conclusion VP shunt failure is very common in infants, mostly resulting from obstruction and infection. Future studies should focus on methods designed to avoid these complications or on alternative treatments for hydrocephalus.

Endoscopic third ventriculostomy (ETV) allows the cerebrospinal fluid (CSF) to flow directly from the third ventricle through the fashioned ventriculostoma to the interpeduncular cistern, by passing the site of obstruction. In spite of the wide variety of indications where ETV is implemented, its success rate is still debatable especially in certain age groups, where it is most successful in adult patients with obstructive hydrocephalus and it has an identifiable failure rate in children less than 6 months of age. Several factors would affect the success rate of ETV, which are related to the patient's age, pathology, and intraoperative findings. This chapter covers most of the current debates considering ETV.

Objectives:Surgical resection of low-grade gliomas (LGGs) in eloquent areas is one of the challenges in neurosurgery, using assistant tools to facilitate effective excision with minimal postoperative neurological deficits has been previously discussed (awake craniotomy and intraoperative cortical stimulation); however, these tools could have their own limitations thus implementation of a simple and effective technique that can guide to safe excision is needed in many situations.Materials and Methods:The authors conducted a retrospective analysis of a prospectively collected data of 76 consecutive surgical cases of LGGs of these 21 cases were situated in eloquent areas. Preoperative functional magnetic resonance imaging (fMRI), pre- and post-operative MRI with volumetric analysis of the tumor size was conducted, and intraoperative determination of the craniometric points related to the tumor (navigation guided in 10 cases) were studied to evaluate the effectiveness of the aforementioned tools in safe excision of the aforementioned tumors.Results:Total-near total excision in 14 (66.67%) subtotal in 6 (28.57%), and biopsy in 1 case (4.57%). In long-term follow–up, only one case experienced persistent dysphasia.Conclusion:In spite of its simplicity, the identification of the safe anatomical landmarks guided by the preoperative fMRI is a useful technique that serves in safe excision of LGGs in eloquent areas. Such technique can replace intraoperative evoked potentials or the awake craniotomy in most of the cases. However, navigation-guided excision might be crucial in deeply seated and large tumors to allow safe and radical excision.

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BACKGROUND:Intracerebral hemorrhage (ICH) accounts for 10-15% of strokes worldwide. Anticoagulation has been believed to induce ICH for a long time; however, oral anticoagulants can have some beneficial impact, especially on the patient's outcome. OBJECT:This study demonstrates how the history of oral anticoagulant administration can affect the outcome of patients surviving spontaneous intracerebral hemorrhage. METHODS:A retrospective analysis of prospectively collected data of 93 patients were included in the study. All patients underwent thorough neurological examination and the size of the hematoma was calculated in cm3. Patients' outcome was estimated using Extended Glasgow Outcome Score (EGOS) one day after surgery, and 4 months later. Statistical analysis was performed using the Wilcoxon signed ranks test for numeric data, and the Chi-squared test for categorical data, a Cox regression model was used to calculate the degree of correlation.RESULTS: Among the 93 cases, 37 were females and 56 were males, age ranged from 18-90 years (mean= 58,26 ± 9.62),. Fifty-one patients received anti-coagulation, while 42 did not receive anti-coagulation prior to the onset of the condition. The average size of the hematomas was 42.94 ml (± 8.63), and while larger sizes, being recorded with the use of anticoagulation (Mean = 43.75 ± 7.99) than without anti-coagulation( mean= 41.98 ± 9.36) (p value < 0.001 95% conf interval [1.499966 6.000077] . Analysis showed that there was positive correlation between the intake of the anti-coagulation prior to the onset of the symptoms and the overall outcome improvement at the end of the follow-up period. (p value< 0.0001). CONCLUSION:Outcome of survivors of hematoma evacuation in patients who were on oral anticoagulants was better. Further studies are required to improve the clinical practice.

Background: The 12-year collaboration between Greifswald and Cairo Universities in Neurosurgery has recently reached stable steps in post-graduate education represented in the bi-institutional fellowship of Neuro-endoscopy. Aim: We present our new experience of upgrading the level of bi-institutional collaboration to serve for highly skilled undergraduate training. Methods: we started a summer school program for the Egyptian medical students, with the target of allowing better orientation with the specialty Results: 10 candidates (6 males and 4 females) were selected to participate in the program. All candidates successfully finished the summer school and stated they would recommend this activity to their colleagues. Conclusion: We recommend the summer school activities either within the host university or abroad in a collaborate university to the students that would be preselected to fit in the planned program. It is our opinion this would assist the young generations in choosing the suitable career and help in improving the quality of the working teams in Neurosurgery in the future.