Early surgical excision provides effective treatment of huge encephaloceles. Overall, 21% of cases require cerebrospinal fluid (CSF) diversion afterward depending on associated anomalies. Despite their size, giant encephaloceles can have an excellent prognosis with no need for further treatment or CSF diversion.

Aim:In this study, we were assessing the outcome of Endoscopic Third Ventriculostomy (ETV) in infants below six months of age in cases of congenital obstructive hydrocephalus.Materials and Methods:The study was done prospectively on eight cases of obstructive hydrocephalus in infants younger than six months of age to assess the success rate of ETV as a primary treatment for hydrocephalus in this age group; in cases of evident failure, a ventriculo-peritoneal (VP) shunt was applied.Results:Despite eliminating the factors suggested as causes of ETV failure in infants below six months; the type, as with the communicating hydrocephalus, the thickness of the third ventricular floor, history of previous intracranial hemorrhage or central nervous system infection, still the success rate did not exceed 12.5%.Conclusions:The complication rate following ETV was low in comparison to the high frequency (20–80%) and seriousness of the possible postoperative complications following VP shunt with a significant decrease in the quality of patients’ lives. Hence the decision-making as well as the parental counselling were in a trial to estimate the ETV success or the need to perform a shunt in the treatment of obstructive 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 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.

Clipping of paraclinoid internal carotid artery aneurysms related to the superior hypophyseal artery (SHA) carries risk of occlusion of this artery when originating distal to the neck of the aneurysm. Sometimes it is inevitable to sacrifice the artery to achieve total aneurysm occlusion. Otherwise a residual aneurysm would remain, which may lead to aneurysm regrowth and subsequent rupture. However, consequences of SHA sacrifice are rarely reported in the literature. In the two presented cases, the SHA was found originating distal to the neck and within the wall of the aneurysm, making the optimal clipping of the aneurysm at the neck unfeasible without trapping of the SHA. Intraoperative indocyanine green (ICG) angiography revealed a retrograde blood flow in the SHA distal to the clip in both patients, indicating some collateral circulation. No endocrinologic deficits were encountered after surgery. The vision was not affected in one patient. In the other patient, bilateral visual field defects occurred, which improved partially in the follow-up 2 months after surgery. The consequences of SHA occlusion are difficult to predict. A large variety of anatomical variations of the vascular anatomy exists. Intraoperative ICG angiography may help to estimate collateral blood flow but is not able to predict visual decline. Although final conclusions cannot be drawn from two patients, it seems that in case of multiplicity of superior hypophyseal complex, sacrifice of one even larger branch is safe. However, visual sequelae have to be taken into consideration when a single SHA has to be sacrificed for total aneurysm clipping.

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.

Background Postoperative shunt infection is a nightmare in neurosurgical practice with additional morbidity and mortality. A lot of protocols have contributed to the reduction of ventriculoperitoneal shunt (VPS) infections but not eradication. The aim of the study was to evaluate the rigid application of a modified Hydrocephalus Clinical Research Network (HCRN) protocol in the prevention of postoperative shunt infection. Methods We retrospectively evaluated children with congenital hydrocephalus who underwent VPS insertion, and in whom the protocol was applied from June 2019 to January 2020. Follow-up ranged from 11 to 24 months. Results Thirty-seven procedures were performed including 35 primary shunt insertions and two revision surgeries. The median age was 5 months (range, 1–30 months), and 25 patients were males. The most common cause for VPS placement was congenital hydrocephalus without identifiable cause in 28 cases (80%). The endoscope-assisted technique was used in the insertion of the proximal end in six cases (17%). The mean follow-up was 19.4 months (11–24 months). The rate of shunt infection was 0% till the last follow-up. Conclusion The preliminary results showed an effective method for the prevention of postoperative shunt infections using the modified protocol. These initial findings need to be validated in a large prospective study before widespread application can be recommended.