Open Journal of Modern Neurosurgery

Journal Information
ISSN / EISSN : 21630569 / 21630585
Current Publisher: Scientific Research Publishing, Inc. (10.4236)
Total articles ≅ 237
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Abbass Waleed, Adel Ghoneim Mohamed, Waleed Abbass, Mohamed Adel Ghoneim
Open Journal of Modern Neurosurgery, Volume 10, pp 230-236; doi:10.4236/ojmn.2020.102024

Abstract:
Background: Spontaneous descent of the CSF (Cerebrospinal fluid) from the nose is called rhinorrhea. The causes are defects in bones of the base or meningeal tear. The surgical management is still a challenge. The surgical repair is a must to prevent the complication which could be brain abscess, meningitis, or pneumocephalus. The available surgical management is either transnasal, or transcranial. The endonasal route represents an easy access but equally aggressive alternative and of limited access. Objective: We reviewed the clinical outcomes of thirteen cases of spontaneous CSF leakage managed by transcranial intradural approach. Patients and Methods: This is a retrospective study about the records of 13 patients who underwent transcranial intradural approach as a surgical management for spontaneous CSF rhinorrhea in our department in the period between November 2017 and October 2019. Results: CSF leakage stopped after initial surgery in 12 of 13 patients, giving a success rate of 92.3%. The remaining case did not agree for new surgery and the case resolved without surgery for this patient. Postoperative complications included superficial wound infection in one patient, and anosmia in one patient. No other neurological problems were encountered over the ten-months’ follow-up period. Conclusion: The transcranial route is the treatment of choice for patients with anterior cranial fossa spontaneous CSF rhinorrhea. A satisfactory surgical outcome depends on exact diagnosis, proper operative approach, and the surgeon’s skills and experience.
Mohamed Adel Ghoneim, Waleed Abbass
Open Journal of Modern Neurosurgery, Volume 10, pp 182-191; doi:10.4236/ojmn.2020.101019

Abstract:
Introduction: Spontaneous spinal infection is an uncommon disease, although the incidence is increasing in the last years. Absence of specific symptoms, and delayed diagnosis result in high morbidity, and mortality. Aim of the Study: To assess the clinical status of the patients, laboratory markers of inflammation, radiological findings, causative organisms, methods of management and their outcome. Patients and Method: Prospective study of 14 patients having spontaneous spinal infection from April 2017 to June 2019. Results and outcome: The study included eight males and six females with mean age of 43.1 years. On Denis pain score, six patients were P5 and eight patients were P4. Fever was found in nine patients. As regards ASIA score, seven patients were ASIA score E (normal motor, and sensory function), six patients were ASIA score D and one patient ASIA score C. Nine patients were found to be diabetic. Laboratory markers of inflammation were elevated in all patients. Two patients were managed conservatively (14.3%) (two cases were TB infection). Twelve patients were managed surgically (85.7%), six of them were TB infection (50%), three were nonspecific infection (25%), one patient was Staph aureus, one streptococci, and one brucella contributing to (8.3%) for each. There was improvement of neurological condition as eleven patients became ASIA score E, and three D and pain had also improved in all patients, ten patients became Denis P1, and four P2. Conclusions: Early diagnosis of spontaneous spinal infection depends on clinical sense to detect patients with back or cervical pain associated with fever and elevated laboratory markers of inflammation. A diagnosis was proved by MRI. Not all cases of Spinal infection need surgery. The indication of surgery is the presence of neurological deficit, spinal instability and failure of medical treatment in case of severe pain. Tuberculosis was the commonest organism as it is endemic in Egypt.
Mustapha Hemama, Nourou Dine Adeniran Bankole, Moussa Denou, Kaoutar Znati, Nizare El Fatemi, Moulay Rachid El Maquili, Hemama Mustapha, Dine Adeniran Bankole Nourou, Denou Moussa, Znati Kaoutar, et al.
Open Journal of Modern Neurosurgery, Volume 10, pp 222-229; doi:10.4236/ojmn.2020.102023

Abstract:
Background: Cystic meningioma is a rare variety of meningioma. It represents 4% to 7% of all meningiomas. The authors report a case of intracranial cystic meningioma with a review of literature. Case Report: A 59-year-old female presented with a history of headache followed by left side hemiplegia. CT scan and MRI of the brain showed a right parietal tumor with double solid and cystic components thought to be pilocytic astrocytoma or metastasis preoperatively. At surgery, the extraaxial solid and cystic lesion had a well defined capsule that could be easily separated from the perilesional cortical surface. The tumor was totally removed and the cyst was punctioned. The histological study showed a cystic meningioma WHO Grade I. A follow-up at 10 months after surgery, the patient was going well and recovered from the hemiplegiaa. Conclusion: Cystic meningioma is an uncommon tumor that should be considered in the differential diagnosis of brain tumors with a cystic component. The preoperative diagnosis and management could be in some cases challenging.
Faye Mohameth, Diop Abdoulaye, Kissao Nissao, Roger Ilunga Mulumba, Djasde Donald, Badiane Seydou Boubacar
Open Journal of Modern Neurosurgery, Volume 10, pp 203-207; doi:10.4236/ojmn.2020.102021

Abstract:
Subdural empyema is not a usual complication of ventriculo peritoneal shunt and the discovery of his calcified form is much exceptional in young adults. We report the case of a female patient of 17 years old carrying a shunt since 16 years who was received for retro auricular suppuration facing the intra ventricular drain and whom cerebral CT-Scan shows a right hemispheric calcified empyema. A large craniotomy was realized in the same time than an external ventricular drain. Evolution was marked by minor right body motor troubles and seizures. Difficulties we have faced during the management are a reminder about morbidity due to the insertion of a ventriculo peritoneal shunt and the need of and long term follow up for the carriers.
Mohamed Mahmoud, Ahmad Elsayed Abokresha
Open Journal of Modern Neurosurgery, Volume 10, pp 208-221; doi:10.4236/ojmn.2020.102022

Abstract:
Background: Treatment of primary spontaneous superficial intracerebral hemorrhage (SSICH) is still controversial. The aim of this study is to investigate the effectiveness of craniotomy and early hematoma evacuation vs conservative (non operative) management in patients with SSICH. Methods: A prospective study of craniotomy and early hematoma removal vs. medical management was performed in 20 patients with cortical and subcortical (superficial) primary SSICH admitted to Assiut university hospital in one year period (March 2016-March 2017). Surgical or medical treatment was initiated immediately when patients admitted to hospital. We divided the patients into two groups according to type of treatment. Results: Age of the patients ranged from 2 months to 73 years (mean: 45.84 ± 23.28 years) among the 20 patients studied; 13 (65%) were males and 7 (35%) were females. Glasgow coma scale (GCS) at admission was less than 8 in 25%, between 8 - 12 in 45% and 15 in 30% of the patients. Arterial hypertension was the most common associated medical disease (65%). Eleven of patients (55%) had ventricular extension. GCS at admission was the strongest factor affecting outcomes and determined the type of treatment. All patients with a GCS ≤ 8 (5 cases (25%) were died regardless the type of treatment and there was no significant statistical difference in this group in relation to type of treatment p-value (0.606). We had 6 cases (30%) with a GCS 15; all of them were treated conservatively and all of them survived with significant p-value (0.003). Nine patients (45%) had GCS 8 - 12; two of them were treated conservatively and died while the remaining seven patients were treated surgically; five of them survived with significant p-value (0.025). No significant statistical difference was found in the outcome between the surgical and the conservative group regarding having associated intracranial hemorrhage. Conclusions: After analyzing the results, we found that when the GCS is “8 - 12”, surgical intervention is recommended and carried a better prognosis than waiting for the conservative treatment. When GCS is higher “>12”, conservative treatment can be the favorable option. Otherwise, we found no statistical difference between surgical and conservative treatment in the treatment of ICH.
Hedaya Hendam, Ahmed Taha, Mohamed Youssef, Hendam Hedaya, Taha Ahmed, Youssef Mohamed
Open Journal of Modern Neurosurgery, Volume 10, pp 19-26; doi:10.4236/ojmn.2020.101003

Abstract:
Background Data: Atlanto-occipital dislocation is a rare and fatal condition. Pain, limitation of movements, and weakness, were the main complaints of patients with upper cervical lesions. Internal fixation and fusion was indicated in all patients of Atlanto occipital dislocation with deficits. CT scan is the imaging modality of choice for evaluation. Objective: To evaluate the efficacy and safety of rod and screw fixation in cranio-cervical instability. Study Design: Retrospective study reviewed all patient treated by rod and screw fixation, they were 12 patient operated for atlanto-occipital instability from April 2013 to April 2016 in Alazher University Hospital Damietta. Pre and postoperative data collection and analysis of the outcome were completed based on the Frankel classification and grading. Patients and Methods: We operated 12 patients, 10 with traumatic and 2 with pathologically diagnosed Atlanto occipital instability. From April 2013 to April 2016. All patients presented with neck pain, limitation of neck movement, and neurological deficits. The patients were investigated by standard plain X ray to the cervical spine, CT scan and MRI of the cervical spine pre-operatively, and they operated thorough posterior Cranio-cervical fixation. These patients followed post-operatively clinically for improving neural functions and radiologically for alignment, stability, fusion and efficacy of hard ware fixation. Results: The mean age of the studied cases was 42.1 years, trauma was the cause of instability in 10 patients, and 2 patients one with rheumatoid arthritis and one with neoplastic lesion. The mean follows up period is 14.7 months. We used screw rod system in posterior craniocervical fixation with iliac bone graft without operative or post-operative complications. All our patients were improved neurologically post-operatively and no hardware failure during the follow up period. Conclusion: Craniocervical instability was rare condition, with miss diagnosis and may be fatal condition. Posterior occipitocervical fixation when indicated can be done by various techniques. The screw rod system was the most upgraded used technique with immediate rigid fixation. Surgery in this area was possible with confident results.
Ahmed Farahat, Hesham Elshitany, Mohamed A. R. Soliman, Farahat Ahmed, Elshitany Hesham, A. R. Soliman Mohamed
Open Journal of Modern Neurosurgery, Volume 10, pp 1-8; doi:10.4236/ojmn.2020.101001

Abstract:
Introduction: The exact pathophysiology of spontaneous CSF rhinorrhea is not always understood in some patients. Idiopathic intracranial hypertension (IIH) is now recognized as one of the causes of spontaneous CSF leak in the neurosurgical and ENT literature. Our aim was to set a management protocol for such cases according to the same setting intracranial tension (ICT). Methods: We prospectively managed patients with spontaneous CSF rhinorrhea who were admitted to our hospital between 1st of January 2014 and 31st of December 2017 with a prespecified treatment algorithm. Patients with a history of previous cranial or nasal surgery, trauma, skull base congenital malformations were excluded from the study. The patient’s demographics, clinical data, comorbidities, body mass index (BMI), first time or recurrent leakage and duration of the leak were collected. Results: 41 patients, 35 females and 6 males, presented with spontaneous CSF rhinorrhea with a mean BMI of 38 ± 4.16 Kg/m2. The mean pre-operative ICT manometry was 17.2 ± 5.9 cmH2O (range, 10 - 26 cmH2O). 43.9% of the patients were found to have an increased ICT (≥20 cmH2O) and underwent a permanent CSF diversion at the same setting of the endoscopic repair. None of the patients had a recurrence during the follow-up period. Conclusion: The prespecified treatment algorithm with measuring the ICT at the same setting of the endoscopic repair has a better result for control of spontaneous CSF rhinorrhea. This has led to no recurrence and decreased hospital stay.
Christine Milena Sayore, Nabil Adio Mousse, Mohammed Yassaad Oudrhiri, Nadia Cherradi, Adyl Melhaoui, Abdessamad El Ouahabi, Milena Sayore Christine, Adio Mousse Nabil, Yassaad Oudrhiri Mohammed, Cherradi Nadia, et al.
Open Journal of Modern Neurosurgery, Volume 10, pp 9-18; doi:10.4236/ojmn.2020.101002

Abstract:
Primary intracranial ependymomas originate from ependymal cells. They may migrate mainly in the spinal cord but rarely metastasize outside the central nervous system. Metastases outside the central nervous system are rare. Metastatic diffusion from the central nervous system is low due to the unique interaction of the brain and the tumor with the blood-brain barrier. Nevertheless, three main hypotheses have been mentioned in the literature, the tumor growth, the surgical manipulation (which may be considered to be the case in our patient), and the aggressiveness of the tumor according to the Ki67 index. We report the case of a 16-year-old female, who underwent complete surgical removal of a left occipital 2007 WHO grade II ependymoma. 3 years later, the patient presented multiple cervical and occipital indurated masses. MRI showed a left hemispheric meningeal infiltration, with multiple nodules located on the neck, occiput and mastoid. Histopathological study of a left temporal surgical biopsy and resection of an occipital subcutaneous nodule turned to be metastases of an anaplastic ependymoma. The ependymoma considered as a benign tumor could very quickly turn into malignancy by its metastatic potential. Early diagnosis and longer follow-up of patients would be recommended for a rapid management.
Hedaya Hendam, Ahmed Taha
Open Journal of Modern Neurosurgery, Volume 10, pp 51-62; doi:10.4236/ojmn.2020.101006

Abstract:
Objective: To evaluate the factors affecting the surgical outcome of traumatic intracranial hematoma. Patient and Methods: This study was retrospectively conducted on 60 patients with traumatic intracranial hematoma admitted to the Neurosurgery Department, Al-Azhar University Hospital and underwent surgical management. Results: The age range was 10 - 58 years, mean age was 31.50 years, male-to-female ratio was 3:1. The causative trauma was road traffic accident (45%), direct trauma to the head (30%) and fall from height (FFH) (25%) of all studied patients. Morbidity and/or mortality was reported in 38.3% and unfavorable outcome was significantly associated with longer delay time (time from injury to surgery), increased operative time, long duration of hospital stay and lower Glasgow coma scale at admission and discharge. Otherwise, the unfavorable outcome although increased with old age, there was no significant association. Conclusion: Head trauma is considered as a frequent cause of death and disability. Time consuming to reach the hospital, operative time, length of stay in hospital and Glasgow coma score of the patient on admission and discharge markedly determine the surgical outcome of traumatic intracranial hematoma.
Khaled Ismail Abdelaziz, Radwan Nouby, Mohammad Fekry Elshirbiny, Ahmed Salaheldin Mahmoud, Ismail Abdelaziz Khaled, Nouby Radwan, Fekry Elshirbiny Mohammad, Salaheldin Mahmoud Ahmed
Open Journal of Modern Neurosurgery, Volume 10, pp 135-145; doi:10.4236/ojmn.2020.101014

Abstract:
Background: The optimal surgical technique for lumbar spondylolithesis remains debated. Although posterior lumbar interbody fusion (PLIF) theoretically offers more advantages than posterolateral lumbar fusion (PLF), the evidence remains inconclusive. Aim: The aim of this study is to compare the clinical and functional outcomes of PLIF versus PLF in patients with lumbar spondylolithesis. Patients and Methods: We enrolled 38 patients with lumbar spondylolithesis (degenerative and isthmic) who underwent PLIF (N = 19) or PLF (N = 19). We collected operative data and performed follow-up for 12 months after the surgery. The collected data were analyzed using the SPSS software to detected significant differences between both groups. Results: The PLF and PLIF groups exhibited similar pre-operative characteristics between both groups in terms of age (p = 0.57), sex (p = 0.73), clinical presentation (p = 1), required levels of fixation (p = 1), pre-operative VAS score (p = 0.43) or muscle weakness (p = 1). However, the PLIF group had significantly more blood loss and longer operative time than the PLF group. Moreover, both groups had similar levels of postoperative pain (up to six months after surgery), and post-operative complications. The rates of arthrodesis were higher in PLIF group than PLF group within six months while no significant difference within 12 months of follow-up. Conclusion: In our comparative study, we achieved comparison between pedicle screw fixation with posterolateral fusion alone (PLF) in compare with pedicle screw fixation with posterior lumbar interbody fusion (PLIF). Results indicate better results of fusion rate in PLIF as regards arthrodesis with slightly more rate of complication than PLF. So we recommend PLIF in cases of lumbar spondylolithesis than PLF.