Background: Endoscopic third ventriculostomy (ETV) is an effective alternative to ventriculoperitoneal shunting as well as external ventricular drainage for the urgent management of acute hydrocephalus. We performed this study to investigate the efficacy and safety of ETV before tumor resection in managing hydrocephalus in patients with posterior fossa brain tumors (PFBT) in our neurosurgery department. Methods: We conducted this retrospective observational study between February 2018 and February 2020 on all cases diagnosed with PFBT associated with triventricular obstructive hydrocephalus. We retrospectively reviewed the demographic characteristics, operative procedures, and radiological investigations of all cases. During the follow-up period, clinical, as well as radiological success were evaluated. Results: Twenty-two ETV procedures were performed in 22 cases of PFBT (mean age = 22.1 years, SD = 11.4). Of the 22 cases, 8 cases (36.4%) had ependymoma, 7 cases (31.8%) had cerebellar astrocytoma, and 5 cases (22.7 %) had medulloblastoma, while 2 cases (9.1%) had diffuse pontine gliomas. The median follow-up duration was 9 months (range 3–13 months). The most commonly reported clinical presentation was the significant intracranial pressure increase. All operations were performed successfully in all cases. Only two ETV post-tumor resection failures were documented during the follow-up period. Conclusion: Preoperative ETV has shown to be an effective long-term cerebrospinal fluid diversion procedure to manage PFBT-associated hydrocephalus, with a relatively low rate of complications. Further prospective studies are required to assess the regular use of ETV before complete tumor resection.
Introduction: Problems with appearance may negatively affect the mental health of individuals with disfigurement so, cranioplasty has an important role in improving the physical appearance of patients as well as their psychological symptoms. Objective: This study aims to highlight the aesthetic as well as the psychological outcomes of cranioplasty using the two most widely used synthetic graft materials; polymethyl methacrylate (PMMA) and titanium mesh. Methods: This is a prospective study conducted on patients with apparent skull deformity who underwent cranioplasty using PMMA or titanium mesh from April 2016 to April 2017 and were followed up for one year. Patients were assessed preoperatively, at three months, and one year postoperatively using the Derriford Appearance Scale 24 (DAS 24) and the Hospital Anxiety and Depression scale (HADS). Results: 42 patients; 25 males and 17 females were recruited. PMMA was used in 23 patients while titanium mesh was used in 19 patients. There were no significant differences regarding early and late complications between both groups. Revision surgery was necessary in only four cases having equal rates between both groups. There was a marked reduction in DAS 24 and HADS scores postoperatively with better scores in the PMMA group especially at three months after cranioplasty. Conclusion: Cranioplasty had positive effects on patients' distress regarding their appearance and their psychological symptoms. PMMA had better parameters than titanium mesh. Both PMMA and titanium mesh had comparable aesthetic outcomes with no statistically significant difference regarding the complication rates. Keywords: Cranioplasty, Polymethyl methacrylate, Titanium, Physical Appearance, Body, Depression (source: MeSH NLM)
Background Lumboperitoneal (LP) shunting is an effective treatment option aiming at cerebrospinal fluid diversion in cases of idiopathic intracranial hypertension. Confirming the distal end position, on the other hand, could be technically difficult, especially in obese people. With minimal invasive procedures, laparoscopic-assisted placement of the peritoneal side of the LP shunt became a valid treatment option. In this study, we aim to evaluate the operation duration, possible complications, and patient outcomes after the placement of a peritoneal catheter using the laparoscopically assisted technique. Methods A retrospective analysis of clinical, preoperative, and postoperative data for 18 patients diagnosed with idiopathic intracranial hypertension and undergoing LP shunt surgery using the laparoscopic-assisted technique for intraperitoneal catheter placement between 2019 and 2021 was performed. Results The average operating time was 93.89 min, and the average hospital stay was 2.3 days. There was no mortality among cases treated with the described technique, and no intraoperative complication occurred. Seven patients (38.9%) had LP shunt failure, with a median duration to failure of 212 days; three cases for slippage, two cases had over drainage, one case had peritoneal adhesions around the shunt tip, and one case had Arnold Chiari malformation. Conclusions The laparoscopic assisted technique is safe and feasible. It allowed a direct vision of the shunt tip position within the peritoneal cavity which helped in confirming position and assessing function, resulting in a superior option over classic surgical options. Short hospital stay, minimal postoperative pain, and low failure rates are the main advantages of described technique.
Background Data: Cranial facet joint violation (FJV) by pedicle screws may increase stress to the level adjacent to the instrumentation and may contribute to adjacent segment disease (ASD). Purpose: This study determines the frequency and risk factors for cranial FJV during pedicle screw instrumentation in various lumbar spine disorders. Study Design: A retrospective study. Patients and Methods: The data and imaging of adult patients with pedicle screw instrumentation for lumbar disorders from June 2018 to June 2021 were retrospectively reviewed for cranial FJV rate and evaluated for the role of the technique of instrumentation (conventional open or percutaneous), the facet angle (FA), the lumbar level, and the type of the disorder as risk factors for this violation. Preoperative Magnetic Resonance Imaging (MRI) was reviewed to measure the FA using T2 axial images. Postoperative Computed Tomography (CT) scans were examined to determine and grade cranial FJV. Results: The study included 360 patients. The overall FJV rate was 17.6%. The FJV rate significantly increased among the percutaneous fixation group compared to that of the open one (29.2% vs. 15.9%, respectively, p = 0.001). Patients with FJV had significantly larger FAs (p < 0.001). Moreover, patients with significantly larger FAs had higher grades of FJV (p value < 0.001). The FJV rate significantly increased with FAs > 40.12° (p < 0.001). L5 level and degenerative disease were more prone to FJV and higher grades of violation. Conclusion:The method of fixation, FA, lumbar level, and the type of lumbar disorder were the independent predictors of cranial FJV. This study reported a higher rate of FJV among patients with percutaneous fixation. The larger the FA, the higher the FJV rate and grade, especially with FAs > 40.12°, L5 level, and degenerative disease. (2021ESJ242)
The sacropelvis is not only an anatomically complex region but also a biomechanically unique zone transferring axial weights via the transitional lumbosacral junction and the pelvic girdle to the lower appendicular skeleton. When the sacral instrumentation alone is insufficient to achieve stability and solid arthrodesis across the lumbosacral junction, as in long-segment fusions, high-grade spondylolisthesis, deformity corrections, complex sacral/lumbosacral injuries, and neoplasms, sacropelvic fixation is indicated. Many modern sacropelvic fixation modalities outperform historical modalities, especially the conventionally open and percutaneous iliac and S2-alar-iliac screw (S2AI) fixation techniques. Novel screw insertion technologies such as navigation and robotics and modern screw designs aim to maximize the accuracy of screw placement and minimize complications. This review addresses the anatomy and biomechanics of the sacropelvic region as well as the indications, evolution, advantages, and disadvantages of various past and contemporary techniques of lumbosacral and sacropelvic fixation.
Introduction: Problems with appearance may negatively affect the mental health of individuals with disfigurement so, cranioplasty has an important role in improving the physical appearance of patients as well as their psychological symptoms. Objective: This study aims to highlight the aesthetic as well as the psychological outcomes of cranioplasty using the two most widely used synthetic graft materials; polymethyl methacrylate (PMMA) and titanium mesh. Methods: This is a prospective study conducted on patients with apparent skull deformity who underwent cranioplasty using PMMA or titanium mesh from April 2016 to April 2017 and were followed up for one year. Patients were assessed preoperatively, at three months, and one year postoperatively using the Derriford Appearance Scale 24 (DAS 24) and the Hospital Anxiety and Depression scale (HADS). Results: 42 patients; 25 males and 17 females were recruited. PMMA was used in 23 patients while titanium mesh was used in 19 patients. There were no significant differences regarding early and late complications between both groups. Revision surgery was necessary in only four cases having equal rates between both groups. There was a marked reduction in DAS 24 and HADS scores postoperatively with better scores in the PMMA group especially at three months after cranioplasty. Conclusion: Cranioplasty had positive effects on patients' distress regarding their appearance and their psychological symptoms. PMMA had better parameters than titanium mesh. Both PMMA and titanium mesh had comparable aesthetic outcomes with no statistically significant difference regarding the complication rates. Keywords: Cranioplasty, Polymethyl methacrylate, Titanium, Physical Appearance, Body, Depression (source: MeSH NLM)
Facts: Female sexual dysfunction (FSD) is a common yet misdiagnosed condition. The purpose of this study was to examine this problem in Egypt and explain the effects of CLBP on the sexual lives of women. Methods: 200 married women with persistent low back pain participated in this cross-sectional research. All patients had a thorough history and clinical examination, as well as a 25-question self-report questionnaire with additional questions tailored to the study's objectives. English and Arabic are used to write this piece. To guarantee the privacy and security of all collected data. Results: 35% of the 30-39-year-old individuals had a positive history of FGC, and 54.8 percent had no history of FGC. While 33.7% of individuals who had never had FGC and no one with FGC had frequency from 3 to 4 times, there was a statistically significant relationship between the patients' age, marital age and frequency of sex. FGC exposure reduced frequency in 18.5% of participants, who reported satisfaction with the frequency of intercourse and frequency of wetting in the bed during intercourse (88 percent and 63 percent of participants unexposed and exposed respectively get wetduring intercourse in more than 50 percent of sexual encounters). Conclusion: 54.8 percent of female chronic low back pain patients had female sexual dysfunction. Chronic low back pain was linked to decreased female erections.
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