Background Data: Traditionally, lumbar canal stenosis (LCS) has been treated with conventional laminectomy involving wide resection of posterior supporting structures of the lumbar spine such as the supraspinous and inter-spinous ligamentum complex, the spinous process as well as wide areas of the lamina. In addition, this required a large incision of the skin and underlying musculoligamentous complex (posterior tension band). Purpose: The current study focuses on the clinical outcome and utility of minimally invasive microendoscopic decompression from a unilateral approach in surgical management of patients with single and multiple level lumbar canal stenosis. The objective is to describe the indications, significance and applications of endoscopic spine surgery in patients with single and multiple level LCS. Additionally, to highlight important anatomical perspectives of the technique and share surgical experience and results. Study Design: A retrospective clinical case study. Patients and Methods: From May 2008 to January 2016, 583 consecutive patients were treated for LCS and included in this study. Patients' main complaint was bilateral neurogenic claudication in addition to back pain and sciatic neuralgia. Single level decompression was performed in 468 (80%) patients and multiple level decompressions in 115 (20%) patients. Magnetic resonance imaging (MRI), computed tomography (CT) scan and plain X-rays were performed for all patients to confirm evidence of central stenosis and then repeated postoperatively. All patients were followed up for at least 3 months and their data collected. Clinical and functional outcomes were assessed using Visual Analogue Scale (VAS) and the Japanese Orthopedic Association Score (JOA) score for lumbar disease. Results: Compared to preoperative complaint, there was an improvement of back pain in 77.9% of patients and in radiating leg pain in 86.3%. With regards to functional outcomes, median preoperative JOA score was 14.93 ± 0.48 and improved postoperatively to 27.17 ± 1.45 (p < 0.001). The mean operating time per level was 78 minutes, and the mean intraoperative blood loss per level was 18 ml. Complications mainly included dural tears in 27 (4.6%) patients, transient postoperative dysesthesia in 46/583 (7.9%) patients and excess bony work in the form of unintended medial facetectomy in 38/583 (6.5%) patients and fracture of the spinous process in 3 (0.5%) patients.

Background: The relationships of the fourth ventricle to the cerebellar surfaces and the fissures through which the fourth ventricle is approached surgically are among the most complex in the brain. The area in and around the fourth ventricle may be affected by a variety of neoplasms. Some are unique to the fourth ventricle; others are also found in different locations. The two most common surgical approaches to the fourth ventricle are the transvermian and the telovelar approaches. The aim of this study: The aim of this study is to compare the results of telovelar and transvermian approaches in the management of fourth ventricular tumors with regard to clinical outcome and extent of tumor excision.

Percutaneous chemical dorsal sympathectomy is an easy, effective, and safe procedure for control of palmar hyperhidrosis.

Background Epilepsy is a chronic debilitating disease especially in pediatric population. Most of reported studies for corpus callosotomy as a palliative surgery in drug-resistant cases are on limited number of cases and there is scarcity in literature for outcomes reported from developing countries. Here, we present our study on a large series of cases with analysis of potential predicators outcomes in the era of more expensive devices like vagal nerve stimulation to give a litany on a universal epilepsy surgery procedure which had been missed in the literature through the last decade. Results An observational retrospective study was done reviewing 129 patients with PEE underwent open microscopic corpus callosotomy. Total and drop attack seizure outcomes were studied after surgery. Potential outcomes predictors studied are: preoperative EEG and MRI. Preoperative IQ impairment epilepsy duration, age at diagnosis, MRI finding, IQ score, EEG findings, history of infantile spasm and extent of callosotomy done. All the recorded outcomes were substantially improved after callosotomy in our study population of 129 pediatric patients. The median (IQR) preoperative drop attack frequency was 70 (21–140) which decreased to 3 (0–14) postoperatively. Similarly, the number of anti-epileptics used by patients had a median of 3 (2–4) which decreased to 2 (2–3) after the surgery. All patients were experiencing status epilepticus which disappeared in 72% of the patients after callosotomy. Preoperative normal MRI was a predictor for drop attack favorable outcome and mild preoperative impairment of IQ was a predictor of favorable total seizure and drop attack outcome. Conclusions Corpus callosotomy is a well-tolerated palliative procedure for drug-resistant generalized epilepsy notably, drop attacks which had its notorious effect on quality of life of pediatric patients and their families, no appreciable prognostic factors for favorable outcome were clearly observed except for normal preoperative MRI, mild preoperative IQ affection, and complete callosotomy.

Background Pathology in the sellar and suprasellar regions accounts for several disabling and distinctive neurological syndromes characterized by visual failure and upper cranial neuropathies. These features have a major impact on functional outcome more than the commonly associated endocrine morbidity. Objective this study aimed to present the incidence of various lesions in the sellar and suprasellar area and evaluate the different protocols for management of these lesions. Methods The study will include 40 cases of sellar& suprasellar lesions that will be admitted and treated in the neurosurgical departments in Ain Shams University Hospital as well as El-Galaa armed forces hospitals and 57375 Children Cancer Hospital between 12/2015-9/2018 Results: Pituitary adenoma was the most frequent(42.5%), followed by craniopharyngioma(30%), then Meningioma(12.5%) with other low frequent diagnoses , Headache was the most common complaint followed by blurring of vision, diplopia and nausea & vomiting. MRI sella was the most valuable investigation. 3 approaches were used and trans-sphenoidal approach was the most common used approach. Postoperative radiotherapy was significantly most frequent in Craniopharyngioma followed by pituitary adenoma and least frequent in meningioma. Conclusion we have reached to conclusion from this study, that transsphenoidal approach was suitable for most pituitary adenomas and Its main indication was mainly midline sellar and suprasellar tumors with limited lateral or posterior extension. The pterional approach was suitable for meningiomas and craniopharyngiomas and Its indication was a supra-or parasellar lesions with both lateral and posterior extension specially those reaching the clivus. Total excision was most frequent in pituitary adenoma followed by meningioma and least frequent in craniopharyngioma. Postoperative radiotherapy was significantly most frequent in Craniopharyngioma followed by Pituitary Adenoma and least frequent in meningioma.