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Object: To evaluate the efficacy and safety of trans-sulcal or fissure approach in surgical treatment of supratentorial lesions Study design: Retrospective clinical case series Methods: This study included 42 patients. Age ranged from 4 to 78 years. Sulcal dissection was done in 26 patients at or near the eloquent areas, and in 16 patients, it was done in non-eloquent areas. Diffusion tensor tractography, neuronavigation, and intraoperative monitoring were applied for lesions at the motor areas. The follow-up period was 24 months. Results: Gross total excision could be achieved in 52% of patients. Sulcal dissection was easy in 26 patients with the lax brain. The outcome, according to the Karnofsky scale, was 100 in 21/42 (50%). Complications were transient deterioration of function in three patients, and immediate post-operative hemorrhage in two patients. Three patients became seizure-free after surgery. Conclusion: The trans-sulcal dissection is a safe, useful, and applicable approach. Through which it is possible to reach deeply seated lesions. It preserves the motor functions, provides wider exposure, minimizes the need of brain retraction during surgery, and preserves the gyral layers. Complications are usually transient, specially in the presence of preoperative diffusion tensor tractography, intraoperative neuronavigation, and monitoring.

Background Microvascular decompression is the definitive treatment of various neuralgias affecting cranial nerves. The compression on a cranial nerve could be at the root entry zone, especially the trigeminal nerve. Endoscope-assisted microsurgery may help avoid missing a hidden vascular structure. Study design Retrospective clinical case series. Patient and methods Twenty-five patients with facial pain and five patients with hemifacial spasm constituted this study. FIESTA MRI was the pre-operative neuroimaging modality. Retrosegmoid craniectomy was done for all patients. Microscope was initially used for exploration and arachnoid dissection around the nerve. The endoscope was applied thereafter for exploration and confirmation of the proper insertion of the Teflon. Results Using the endoscope, cerebellar retraction was reduced by 0.5 to 0.8 cm in 90% of patients. Root entry zone and entry of the nerve through the corresponding skull base foramen was clearly visualized by the endoscope. Endoscope enabled a wider area of exploration and panoramic view, which could not be obtained by the microscope. Patients with trigeminal neuralgia had a median pre-operative VAS of 9, while it was only 1 in early post-operative and 0 in 6-month post-operatively. Patients with HFS were completely recovered. Conclusion The advantages of microvascular decompression are still worthy. Complications are minimal, and the view is much more panoramic. The different viewing angles and ability to directly reach corners is an absolute endoscopic advantage. Therefore, avoidance of missing vascular structures and incomplete recovery can be assured.

Background Data: Surgical treatment of isthmic spondylolisthesis includes decompression, fixation and bone fusion. There are different suitable techniques for fusion as (PLF) posterolateral fusion (TLIF) transforaminal lumbar interbody fusion, (PLIF) posterior lumbar interbody fusion, (ALIF) anterior lumbar interbody fusion but still controversy remains about the best technique. Purpose: To evaluate and compare the surgical results of PLF versus TLIF with pedicle screw fixation in treatment of low-grade isthmic spondylolisthesis. Study design: A prospective randomized clinical case series. Patients and methods: This study included 40 patients with low grade isthmic spondylolisthesis. All patients were surgically treated by posterior decompression, transpedicular screw fixation and bone fusion. Patients were divided into two equal groups according to the type of bone fusion. Group A included 20 patients treated with PLF, and Group B included another 20 patients and were treated with TLIF. We used Visual Analogue Scale (VAS) for assess pain and the Oswestry Disability Index (ODI) to evaluate the functional outcome among our patients. Patients have been followed up for at least six months after surgery. Results: The improvement of VAS of back pain was significantly greater in group B (TLIF) (change 5.25±1.55) than in group A (PLF) (change, 4.4±1.14) (P<0.05). There was no significant difference in improvement of ODI in both groups. Patients with BMI³30 showed that group B experienced more clinical improvement than in group A in the VAS (P=0.021). The operative time in group B (185±24.5 min) was significantly longer than in group A (123.3±19.6 min) (P=0.034). Intraoperative blood loss in group B (584±192.1 ml) was significantly greater than in group A (417±182.4 ml) (P=0.008). The complication rate in group A (30%) was significantly less than in group B (55%) (P= 0.032) but broken screws (hardware failure) were more common in group A (20%) than in group B (0.0%) (P=0.01). The fusion rate in group B (95%) was higher than in group A (75%). Conclusion: Our data suggest that although TLIF is better than PLF in achievement of successful bone fusion and improvement of patient's symptoms (back pain and sciatica), PLF still considered simple technique with minimal operative blood loss, less operative time and little complications. (2018ESJ162)

Background Autologous Platelet gel may become an ideal autologously prepared biologic blood-derived product that can be exogenously applied to a diversity of tissues, in which it releases high concentrations of platelet growth factors that enhance healing. Aim of the Work to evaluate the role of platelet gel in promoting healing in phalangeal fractures. Patients and Methods This study was conducted on 20 Patients were operated either by general or local anesthesia in a prospective interventional study for: evaluation the role of platelet gel in promoting healing of phalangeal fractures after fixation by Kirschner wires. Results In this study: clinical and radiographic signs of healing at 12wks were achieved in 70% of studied patients and 16wks were achieved in 30% of studied patients and early improvement of swelling and tenderness. Conclusion The use of Autologous platelet gel in phalangeal fractures after fixation by Kirschner wires gives a significant improvement quickly over the periods according to swelling, tenderness and x-ray healing So decrease recovery time and return to work and activities.

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Background: There are significant changes in breast shape and contour during the 1 st post-operative year after any breast reduction technique. Our work was dedicated to study the post-operative changes and aesthetic outcome in the superior and medial pedicle vertical scar reduction mammoplasty techniques. Patients and Methods:The study was conducted on 20 female patients suffering from bilateral large breasts. They were divided equally into two groups using simple randomization. Group I (10 patients) were operated upon by superior pedicle (modified Le Jour) technique. Group II (10) patients were operated upon by medial pedicle (hall-findlay) technique. Patients were evaluated for esthetic outcomes. This was done through breast measurements and photographic analysis preoperatively, 1, 3 and 6 months post-operatively. Results:There is no significant difference between group I and group II regarding the pre-operative measurements and intra-operative scar length. However, a significant difference was present between both groups for all measurements except IMF level at 3 and 6 months post-operatively. There is no significant difference in the photographic analysis.Conclusion: Both techniques are aesthetically reliable with more bottoming out in findlay technique. Lower pole show is less in modified Lejour technique. Also, two new breast measurements were introduced.

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