BackgroundAcute hydrocephalus can cause neurological deterioration after aneurysmal subarachnoid hemorrhage (aSAH). Predicting which patient would require shunting is challenging.MethodsThis prospective study was conducted upon twenty patients who suffered acute hydrocephalus due to subarachnoid hemorrhage of ruptured aneurysms. Surgical or non-surgical management of hydrocephalus was conducted. Glasgow Coma scale (GCS) was assessed, and hydrocephalus was graded by bicaudate index. Fisher grade was determined from CT scan. Aneurysm site was determined by conventional or CT angiography. Either surgical clipping or endovascular coiling of aneurysms was performed.ResultsInitially, 3 (15%) patients had emergency CSF diversion on admission due to poor GCS on arrival. Initially, the remaining 17 patients were managed conservatively. Five patients did not require any intervention. Twelve patients had external ventricular drainage placement, 4 were weaned, and 8 failed weaning. High bicaudate index (> 0.2) correlated with shunting. Aneurysm site correlated well with shunting (ACoA or PCoA).ConclusionsPatients with fair GCS can be managed conservatively. Any deterioration warrants shifting to CSF diversion. Higher bicaudate index will usually need CSF diversion. The value of Fisher carries no significant value. Aneurysm location (ACoA or PCoA) correlates with an increased incidence of ventriculoperitoneal shunt placement.

The patient-specific titanium meshes and immediate particulate autogenous bone graft showed satisfactory clinical and surgical results in improving patients' quality of life and decreasing the overall treatment time with adequate functional rehabilitation.

HighlightsIntraosseous zygomatic hemangioma is highly prevalent in females compared to males (2.28:1), with mean age of 44.1 ± 1.8 years.The main patient concern in intraosseous zygomatic hemangioma is swelling and facial deformity.Partial resection and curettage are associated with high recurrence rate.Total tumor resection can assure no recurrence proved for over 10 years of follow-up, with minimal intraoperative bleeding occurred in most of the cases.Computer guided surgery for resection and reconstruction of intraosseous zygomatic hemangioma facilitates the surgical procedures.

Purpose: Various treatment modalities have been stated to avoid faulty healing of the mandibular angle fracture and the subsequent functional and esthetic disasters. In this study, we aimed to design a new patient-specific titanium plate to overcome Champy's acknowledged drawbacks and avoid splaying of the inferior border of the mandible. Patients and methods: This study included eight patients suffering from a displaced unilateral mandibular angle fracture with a mean age of 37 years. They all needed open reduction and internal fixation. Preoperative evaluation included the clinical examination through inspection of malocclusion and measurement of maximum inter-incisal mouth opening, along with the radiographic assessment through the screening panoramic view and the 3-D CT examination to determine the amount of displacement between the fractured segments. Computer mirroring of the intact side was done to virtually reduce the fractured side to design a patient-specific plate. This plate aimed to fit on the superior ventral surface of the external oblique ridge, namely; Champ's osteosynthesis line. Downward extended lingual shelf and two buccal arms were added in the plate, to only immobilize the mandible lingually along with fixing both fractured segments buccaly with screws, while fixing the segments superiorly at Champy's line with the standard plate shaft. The titanium PS-plate was processed and fixed in place using 2.0 screws through the standard intra-oral approach after Maxillo-mandibular fixation using ivy-loops. Immediate postoperative mandibular function was allowed. Postoperative clinical assessment of the occlusion and the Maximum inter-incisal opening (MIO) was performed at one week, 1 month and 3 months. Postoperative radiographic CT assessment was performed through measuring the linear inter-fragmentary gap between the fractured segments at the inferior mandibular border. Results: The surgeries in all cases were uneventful. Surgical site was normal with no signs of infection or dehiscence except in only one case, which showed primary intra-oral plate exposure. The preoperative parasthesia recorded in three patients was improved postoperatively, however without its complete disappearance. MIO was significantly improved over the follow-up period to reach a mean of 40.3 mm after 3 months. Radiographic examination, over the follow-up period,

Chronic renal failure patients need renal replacement therapy to sustain their lives. Renal replacement therapy could be either hemodialysis (HD) or peritoneal dialysis (PD). In hemodialysis, a vascular access is created to connect the patient to the dialysis machine; the access could be a central line, a native arterio-venous fistula (AVF) or a synthetic arteriovenous graft (AVG) 1 . AVF provides the best functional patency and the least complications 1 . AVF is the recommended vascular access in patients who need dialysis treatment 2 . Nevertheless, complications, such as AVF aneurysms, steal syndrome, venous hypertension and infections are not uncommon 3 .A recent study on regular hemodialysis patients revealed that AVF aneurysm formation is the most common complication 3 . Background: Arterio-venous fistula (AVF) provides the best functional patency for patients onregular hemodialysis (HD). Nevertheless, complications such as AVF aneurysms, steal syndrome, venous hypertension and infections are not uncommon. Objective: To evaluate the trends in AVF aneurysm formations, prophylaxis and treatment options. Design: A Retrospective, Descriptive Study. Setting: Hemodialysis Centers, Ministry of Health, Kingdom of Bahrain. Method: Two hundred and eleven patients on hemodialysis via arterio-venous fistula and arteriovenous graft were included in the study. Result: Two hundred and eleven patients were on hemodialysis via arterio-venous fistula and arterio-venous graft. Thirty (14.22%) patients developed arterio-venous fistula aneurysm. Sixteen (53.33%) were males, and the mean age was 57 years. Eleven (36.66%) patients had excision of the aneurysms with interposition graft. Six (20%) patients had excision of the aneurysms with new fistula formation. Six (20%) patients required a change of the cannula insertion site while the remaining 7 (23.33%) patients were waiting for their scheduled date of surgery. Conclusion: Aneurysm formation is the most common complication in post AVF patients on regular HD. AVF aneurysms are at high risk of rupture and fatal hemorrhage. Surgical treatments could safely be performed for high risk aneurysms. The most common cause of aneurysm formation is repeated punctures at the same site.