Low-velocity penetrating head injuries are most common in young adult males. With the appropriate management, a majority of even the most severe cases can have a favorable outcome.

Background Gliomas are characterized by high morbidity and mortality with low cure and high recurrence rates, which depends to a great degree on the angiogenesis of the tumor. Assessment of such angiogenesis by perfusion techniques is of utmost importance for the preoperative grading of gliomas. The purpose of this study was to assess the role of arterial spin labeling (ASL) perfusion as a non-contrast MRI technique in the grading of brain gliomas, in correlation with the dynamic susceptibility contrast perfusion imaging (DSC-PI). The study was carried out on 35 patients admitted to the Neurosurgery Department with MRI features of gliomas and sent for further perfusion imaging. Non-contrast ASL followed by DSC-PI was done for all cases. The final diagnosis of the cases was established by histopathology. Results Fourteen patients (14/35) had low-grade gliomas while twenty-one (21/35) had high-grade gliomas. In low-grade gliomas, four cases out of 14 were falsely graded as high-grade tumors showing hyperperfusion on ASL, three of which showed DSC-PI hypoperfusion. In high-grade gliomas, two cases out of 21 were interpreted as an indeterminate grade by ASL showing isoperfusion, however showed hyperperfusion on DSC-PI. ROC curve analysis showed ASL-derived rCBF > 2.08 to have 80.95% sensitivity, 85.71% specificity, and overall accuracy of 82.86% compared to 100% sensitivity, specificity, and accuracy of DSC-PI-derived rCBV and rCBF of > 1.1 and > 0.9, respectively. A significant positive correlation was noted between ASL and DSC-PI with correlation coefficient reaching r = 0.80 between ASL-rCBF and DSC-rCBF (p < 0.01) and r = 0.68 between ASL and DSC-rCBV (p < 0.01). Conclusions ASL is a relatively recent non-contrast perfusion technique that obtains results which are in fair agreement with the more established DSC perfusion imaging making it an alternative method for preoperative assessment of perfusion of gliomas, especially for patients with contraindications to contrast agents.

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Background Data: Lumbar spinal stenosis refers to the anatomical narrowing of the lumbar spinal canal, and is associated with a spectrum of clinical symptoms. The annual incidence of lumbar spinal stenosis is reported to be five cases per 100,000 individuals. Purpose: The purpose of this study is to evaluate the surgical outcome of patients having lumbar spinal stenosis and underwent unilateral approach for bilateral spinal decompression surgery, and to compare outcomes with the conventional laminectomy approach. Study Design: This is a prospective randomized controlled study. Patients and Methods: This study included 21 patients with clinically manifest discoligamentous lumbar spinal stenosis without radiological instability. Eleven patients had bilateral neural decompression through a unilateral microscopic approach (unilateral laminectomy) (Group-I) and the other 10 patients had conventional laminectomy (Group-II).Clinical assessment was done using Visual Analogue Scale (VAS) and ODI. The patients were followed-up for 12 months postoperatively. Results: Thirteen patients were females and 8 were males. The mean age of unilateral approach group was 47.2 years, and 49.5 years for the conventional group. Reported duration of surgery was 100 minutes in group-I and 85 minutes group-II. Reported intraoperative blood loss was 84.7 cc in group-I, and 127 cc in group-II. Clinical improvement was achieved in both groups without significant difference in between regarding VAS and ODI. In group we reported unintended durotomy occurred in two patients, CSF leak in one patient, and hematoma in another patient. In group-I we had one patient of unintended durotomy, one patient had CSF leak, and one patient developed spondylolisthesis. Conclusion: Unilateral microscopic laminoforaminotomy with cross over the top technique, for bilateral neural decompression in lumbar spinal stenosis has equal efficacy and safety with minimal effect on stability and slight better postoperative back pain in comparison to conventional approach. (2017ESJ140)

Background Data: Discectomy through a limited laminotomy has remained the "gold standard" for lumbar disc surgery. Surgery for lumbar disc herniation can be classified into two broad categories;open (conventional) versus minimally invasive surgery , where the last category classified into microscopic, endoscopic and percutaneous procedures. Microendoscopic discectomy (MED) is unique in that it combines open surgical principles with endoscopic technology. Purpose: To evaluate extent of tissue damage and pain relief after microendoscopic (MED) and microscopic lumbar discectomy (MD). Study Design: A prospective randomized controlled study. Patients and Methods: The study included 40 patients having lumbar disc prolapse, operated in Alexandria Main University Hospital. Twenty of them underwent MED (Group A) and the other twenty underwent MD (Group B). Clinical (VAS, ODI) and radiological and biochemical markers (CRP, CPK) for tissue inflammation data were collected preoperatively and postoperatively for comparison. Patients were followed up for 6 months. Results: 26 patients were males and 14 were females. The mean age for group A was 40.8±1.34 years and for group B was 40.2±1.06 years. Clinically all patients had low back pain and radicular leg pain. There was no statistically significant difference between the duration of surgery in both groups. The length of hospital stay was significantly less in MED group. The length of the skin wound was significantly less in MED group. Reduction of back pain VAS immediate and 1 month postoperative was reported in both groups and was statistically significantly better in MED group, however, after 6 months there was no difference between both groups. There was significant improvement with no difference between both groups regarding radicular VAS and ODI all through the follow up. Postoperative CRP and CPK was statistically significantly higher in MD group (P<0.001). Conclusion: Both techniques gave comparable clinical outcomes although early back pain score and tissue markers were in favor of MED technique. (2018ESJ153)