Background Lateral ventricular lesions associated with hydrocephalus are considered a challenge to neurosurgeons. Hydrocephalus after surgery of such lesions and its pathogenesis and how to deal with it is a big question facing neurosurgeons. Objectives In this study, we tried to discuss the pathogenesis and different forms of presentation of hydrocephalus in lateral ventricular lesions and how to deal with it. Methods Eleven patients with lateral ventricular lesions associated with hydrocephalus either preoperative or postoperative presenting to our hospital were managed by excision of the lesion. A prospective study was done for these cases including their clinical data, radiological data, the presence, or absence of hydrocephalus either preoperative or postoperative and how we managed it. Results This study included 11 cases. The mean patient age at surgery was 25 years old. Nine cases were presented with radiological signs of hydrocephalus preoperatively. Two cases developed new onset hydrocephalus after lesion excision. Six cases ended with permanent CSF diversion. Conclusion Management of cases with lateral ventricular lesions does not stand on only excision of the lesion. Hydrocephalus should be kept into consideration perioperatively. We should try to avoid events that could lead to ventriculitis. Prolonged follow-up of the patients postoperative is very important as hydrocephalus may develop later after surgery.

Background: Brainstem glioma is the leading cause of morbidity and mortality among all central nervous system tumors, especially in childhood as it represents about 20% of all pediatric brain tumors. Therefore, this study aimed to present our experience in a tertiary center in a developing country with limited resources for the surgical management of exophytic brainstem gliomas. Methods: This retrospective study included pediatric patients with brainstem (midbrain, pontine, or medullary) focal or diffuse gliomas whether low or high grade that had dorsal, ventral, or lateral exophytic component who were presented to our hospitals from January 2019 to January 2021. The patients’ data were collected, such as age, sex, preoperative and postoperative clinical condition, radiological data, surgical approach, extent of tumor removal, histopathology, follow-up period, and adjuvant therapy. Results: A total of 23 patients were included in this study. The telovelar approach was used in 17 patients, the supracerebellar infratentorial approach in three patients, and the retrosigmoid, transcerebellar, and occipital transtentorial approach once for each patient. Twenty patients underwent near-total excision, and three underwent subtotal excision. Two-thirds of our cases (17 patients) were low-grade gliomas, with the remaining one-third comprising entirely of either anaplastic astrocytoma (five patients) or glioblastoma multiforme (one patient). The follow-up period of the patients extended from 3 months to 24 months. Conclusion: Exophytic brainstem glioma surgery can result in good outcomes with minimal complications when near-total excision is attempted through a properly chosen approach and adherence to some surgical techniques and considerations.

BACKGROUND: Spinal dumbbell shaped tumors are tumors that grow over the constricted intervertebral foramen from the intraspinal canal to the extraspinal region. The best surgical approach for dumbbell tumors in the cervical spine is still debatable. OBJECTIVE:To evaluate the clinical outcome, extent of resection and postoperative cervical spine stability following surgical resection of subaxial cervical dumbbell shaped tumors through the posterior approach. METHODS:Patients with dumbbell shaped tumors in the subaxial cervical spine who were operated upon by the posterior approach in the department of neurosurgery at Cairo University hospitals between January 2019 and January 2021 were evaluated retrospectively. The preoperative and postoperative neurological conditions were assessed using the Japanese Orthopedic Association (JOA) score. Postoperative magnetic resonance imaging was performed for evaluation of the extent of resection. RESULTS:Six patients with subaxial cervical dumbbell shaped tumors underwent surgery via a posterior approach for tumor excision and fusion in 2 years. We reported clinical improvement in 3 cases, 2 cases had a stationary course and only one case showed mild immediate postoperative deterioration that improved within a month after surgery. In five patients gross total resection was achieved, and in one patient subtotal resection was achieved. The pathology was schwannoma in all cases. We reported no vascular injury or mortality in our study. CONCLUSION:For the excision of dumbbell shaped schwannomas in the subaxial cervical spine, one-stage posterior laminectomy with facetectomy appears to be a feasible and effective option. The tumor could be safely and fully excised in the majority of cases.

Background: Cerebral venous sinus thrombosis (CVST) is not a common type of stroke (5%) but still hazardous to be misdiagnosed or mistreated. Aggressive medical treatment is usually failed to hinder increase intracranial tension. Therefore, decompressive craniectomy (DC) is the final measure to mitigate the deleterious effect of supratentorial herniation. The purpose of the study is to illustrate our experience with the surgical treatment of CVST and reviewing the previous works of literature. Methods: Forty-two patients were admitted to Kasr Al-Ainy University Hospital from June 2019 to March 2020. The admission was either to the neurology department or intensive care unit or neurosurgery department. Every patient who was diagnosed with CVST received an emergency neurosurgery consultation. Seven patients were operated on with DC according to the criteria mentioned above. Therapeutic heparin was given in addition to intracranial pressure lowering measures. Results: The mean and standard deviation of the age was (25.14 ± 10.1) years. There were five females (71.45%) in our series. The mean and standard deviation of clinical manifestations are (8.5 ± 7.77) weeks with range (3– 14 weeks). Most of the cases were presented by a decreased level of consciousness (6/7) and anisocoria (6/7), followed by fits (3/7). Four cases out of seven had the previous history of oral contraceptive administration. Conclusion: DC provides an urgent last arm for intractable increased intracranial tension. Patients with CVST need urgent consultation for neurosurgical intervention.

Background: Various surgical methods were described for treatment of lumbar disc prolapse including microdiscectomy, later sequestrectomy was described for preservation of disc height and minimalizing the surgical intervention. Aim of Study:The aim of this study is to evaluate the outcomes of lumbar disc fragmentectomy in patients with lumbar disc herniation in terms of pain (back pain and radicular) relief, improvement of neurological deficit if present, hospital stay duration, time consumed for return to work, and the incidence of complications with this intervention compared to conventional microdiscectomy.Patients and Methods: This is case series study, where patients having lumbar disc herniation were evaluated preoperatively both clinically and radiologically patients were operated by microfragmentectomy and followed-up conducted for 3 months for recurrence rate and outcomes. Results:We operated twenty cases in this study, with microfragmentectomy, the mean age of patients was 34.75 years, there were 15 males and 5 females, postoperative pain improvement was better in microfragmentectomy. Hospital stay, blood loss, and postoperative complications were less in microfragmentectomy. Conclusion:Microfragmentectomy allows good surgical visualization and is less traumatic to the involved tissues. The results of this study indicated that microfragmentectomy reduces hospitalization time, improves the overall surgery related outcome, microfragmentectomy allows patients earlier return to work and normal life with less reliance on postoperative narcotic analgesic agents.