Background: The diagnosis of carpal tunnel syndrome (CTS) is established mainly on a clinical basis, and diagnosis is done after careful history taking and examination including known provocative tests with varying efficacy and reliability. Methods: A prospective clinical study of 123 patients with 171 hands presenting with classical symptoms of carpal tunnel syndrome were included in this study, from October 2013 to October 2015, and they underwent open surgical release of flexor retinaculum at the Neurosurgery Department of Benha University Hospital. Results: ART is positive in 88.3%. This is compared to 75, 81.3, 79.7, and 83.6% of positive results in Tinel's test, compression test, Phalen's test, and combined Phalen's and compression test. ART is the most sensitive and specific test and has the highest positive predictive value of 98.3%, negative predictive value of 81.9%, and accuracy of 91.4%. Conclusion: ART is a simple, reliable, and easily performed test for evaluating carpal tunnel syndrome; it is superior to other tests and could be used also to assess improvement after surgery.

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Background With improvement of health care in last decades, the age of general population increased. As the elderly with degenerative lumbar disease needs to remain physically active for more years, lumbar decompression surgery with instrumented fusion is further considered and is gaining wide acceptance as it provides good results with relative minimal risk. This study aim to evaluate the safety and efficacy of lumbar decompression with instrumented fusion in elderly Results This is a prospective non-randomized clinical study conducted from July 2014 to July 2019. The included patients had chronic low back pain, radiculopathy, and/or neurogenic claudication due to degenerative lumbar disease with failed conservative management. They underwent lumbar decompression with instrumented posterolateral fusion. All patients were at least 55 years old at time of surgery and were clinically assessed as regard perioperative risk and morbidity, besides assessment of pre- and postoperative visual analog score (VAS) and Oswestry Disability Index (ODI). Data was collected and analyzed. Thirty-five patients were included in this study with mean age of 63 years. All patients presented with back pain, 77.1% with radiculopathy, and 60% with neurogenic claudication. Preoperative comorbidity was present in 60% of cases, where hypertension, diabetes, and cardiac troubles were 31.4%, 31.4%, and 14.3% respectively. The average operated level was 3.1. The complication rate was 11.4% with 2 cases with dural tear (5.7%), 2 cases with CSF leakage (5.7%), 1 case with wound seroma (2.8%), and 1 case with wound infection. Postoperative new comorbidity occurred in 5 cases (14.3%). Visual analog score (VAS) and Oswestry disability index (ODI) were recorded preoperatively and 18 months postoperatively; as regards pain, VAS improved significantly from 7.8 ± 0.87 to 1.8 ± 1.04 (P value< 0.00001), and ODI improved significantly from 58.1 ± 11 to 17.5 ± 8.3 (P value< 0.00001). Conclusion Lumbar decompression surgery with posterolateral instrumented fusion is a safe and effective surgery in elderly, as it provides significant results and gives them a chance for better quality of life. Preoperative comorbidity could be dealt with, and it should not be considered as a contraindication for surgery in this age group.

Background: Hydrocephalus is defined as an inappropriate increased pressure of cerebrospinal fluid (CSF) within the intracranial spaces with an inappropriate amount of CSF. Endoscopic third ventriculostomy (ETV) is considered an effective procedure that is safe. Purpose: The aim of the current work was to detect the factors those predict success parameters in selecting patients with idiopathic obstructive hydrocephalus as candidates for the ETV procedure at a pediatric age. Patients and methods: A clinical prospective cohort study was conducted at Benha University Hospitals from September 2018 to July 2021. A total of 61 patients with inclusion criteria of idiopathic (congenital) obstructive hydrocephalus of pediatric age (under 18 years old) with and without previous ventriculoperitoneal (VP) shunt insertion were included according to calculated sample size who undergoing ETV with a follow-up period of 6-12 months. All patients were evaluated by pre and post-operative operative MRI CSF flowmetry.Results: Sixty-one patients were operated on, with age ranged from 3 to 120 months, and the median (IQR) was 13.0 (5.5-24). Previous VP shunting was done in 15 patients (24.6%). According to the receiving operator characteristic (ROC) curve, the cut off point for ETV success age was 11.5 months; while the cut off point for ETV success score (ETVSS) was 70. MRI CSF flowmetry detected and measured the size of the ventriculostomy stoma and evaluated the flow direction and stroke volume. Conclusions: It could be concluded that endoscopy has reliable validity and safety in the treatment of idiopathic obstructive hydrocephalus. ETV success predictors are patients' age above 11.5 months and ETVSS ≥70, led to increase validity of endoscopy. MRI CSF flowmetry is safe and accurate method for evaluation of the ventriculostomy stoma.