Background Encephaloceles are cystic congenital malformations in which central nervous system (CNS) structures, in communication with cerebrospinal fluid (CSF) pathways, herniate through a defect in the cranium. Hydrocephalus occurs in 60–90% of patients with occipital encephaloceles. Objective Assessment of the surgical management of hydrocephalus associated with occipital encephalocele and its effect on the clinical outcome. Methods Between October 2015 and October 2019, a retrospective study was conducted on seventeen children with occipital encephaloceles who were operated upon. The presence of progressive hydrocephalus was determined by an abnormal increase in head circumference and an increase in the ventricular size on imaging studies. A ventriculoperitoneal (VP) shunt was applied in patients who had hydrocephalus. The clinical outcome was graded according to the developmental milestones of the children on outpatient follow-up visits. Results The mean age at surgery was 1.6 (range, 0–15) months. There were ten girls (58.8%) and seven boys (41.2%). Ten encephaloceles (58.8%) contained neural tissue. Ten patients (58.8%) had associated cranial anomalies. Eleven children (64.7%) had associated hydrocephalus: four of them (36.4%) diagnosed preoperatively, while seven children (63.6%) developed hydrocephalus postoperatively. Ten of them (90.9%) were managed by VP shunt. All children with hydrocephalus had some degree of developmental delay, including six (54.5%) with mild/moderate delay and five (45.5%) with severe delay. Half of the patients (50%) of the children with occipital encephalocele without hydrocephalus had normal neurological outcome during the follow-up period (p value= 0.034). Conclusions Occipital encephalocele is often complicated by hydrocephalus. The presence of hydrocephalus resulted in a worse clinical outcome in children with occipital encephalocele, so it can help to guide prenatal and neonatal counseling.

Back ground: Ventriculoperitoneal (VP) shunt is one of the most commonly performed procedures by a neurosurgeon. It is occasionally fraught with the most bizarre complications . Shunt infection in hydrocephalus patients is the most important complication and causes a severe, even life-threatening complication. Objectives: To evaluate outcome of insertion of antibiotic impregnated shunt (AIS) catheter compared to non-AIS catheter for treatment hydrocephalus (HCP) in neonates. Patients & Methods: Prospective part of the study (Group A) included 50 patients fulfilling the diagnostic criteria for HCP and assigned to receive AIS catheter. The retrospective part included 50 n patients age-and gender-matched patients underwent non-AIS catheter for treatment of HCP. Study outcomes included rates of catheter-related infection (CRI) and revision surgery (RS) for CRI. Results: Sixteen patients required RS for CRI; 3 in group A and 13 in group B with significantly lower frequency in group A. Frequency of patients required early RS was significantly lower (p<0.001) and mean duration till development of the 1 st CRI was significantly (p=0.019) longer in group A.Frequency of patients required frequent revision was significantly (p=0.001) lower in group A.Collectively, there were 25 episodes of CRI with significantly lower frequency in group A (p=0.001). Mean number of local CRI findings/patient was significantly (p=0.019) lower and duration of symptoms before diagnosis of CRI was significantly (p=0.02) longer in group A.Thirteen patients showed high leucocytic count, 12 patients had low CSF glucose/serum glucose and 7 patients showed high CSF lactate concentration. Bacteriological examination of replaced catheters showed significantly higher frequency of no bacterial growth in group A, the frequency

Back ground: Traumatic brain injury (TBI) can result in cerebral edema and vascular changes resulting in an increase in intracranial pressure (ICP), which can lead to further secondary damage.Monitoring of ICP is the standard of care for patients with TBI . Objectives: To evaluate outcome of decompressive craniotomy (DC) for management of severe traumatic brain injury (STBI) with persistently elevated intracranial pressure (ICP) on medical treatment and to determine feasibility, safety and accuracy of intraparenchymal ICP monitoring (IPM). Patients and Methods: Forty-one patients admitted to ICU with STBI underwent clinical evaluation. CT scanning was performed for lesions' description and grading with measurement of midline shift (MLS). IPM was inserted and initial ICP was recorded. Patients failed to respond to medical treatment underwent DC. Study outcome included frequency of postoperative (PO) complications and functional outcome judged by Extended Glasgow Outcome Scale (GOSE) 3, 6 and 12-m after hospital discharge. Results: Twentyseven patients underwent early DC, while 14 patients had late DC. Unilateral craniectomy was performed in 38 patients and bifrontal craniectomy in 3 patients with diffuse cerebral edema and no MLS. During 48-hr PO, arterial pressure measures gradually increased, while ICP gradually decreased and CPP was progressively increased. Mean duration of ICP monitoring was 4±2.4 days, mean duration of ICU stay was 6.8±3.4 days and mean total hospital stay was 11.4±5 days. Five patients developed surgery-related PO complications and 12 patients died, but there was no surgery related mortality. At end of 12-m follow-up; 9 patients had good recovery, 9 patients had moderate disability and 3 had severe disability, while 3 patients were in vegetative state. Conclusion: Shortterm trial of medical treatment judged by ICP monitoring of STBI patients allows early surgical

Background Data: Spondylodiscitis is a major clinical condition with significant health and economic burden. There is a controversy regarding the use of conservative therapy with systemic antibiotics alone versus combined with surgery to manage primary spondylodiscitis. Study Design: Retrospective clinical case study. Purpose: To assess the clinical outcome of treatment of the patients with primary spondylodiscitis. Patients and Methods: This study was conducted on 27 patients with primary spondylodiscitis. There were 17 males and 10 females. The mean age was 49.96 ± 9.83 years. All the patients presented with local pain over the involved vertebral level. The clinical outcomes were assessed using the Visual Analogue Scale (VAS), ASIA score, and Kirkaldy-Willis functional outcome criteria. Results: Eight patients (29.6%) were managed by medical treatment alone. Nineteen patients (70.4%) were managed surgically, including seven patients who were operated on by laminectomy and 12 patients by posterior decompression and fusion, followed by subsequent treatment with antibiotics. VAS score was reduced significantly in the patients treated surgically compared with the patients treated medically at 1 and 3 months (P value < 0.001 and = 0.010, respectively) but not at 6 and 12 months of the followup period (P value = 0.235 and 0.886, respectively). There was no significant difference between the two groups regarding CRP and ESR reduction levels, the functional outcome, and the complications at different time intervals. Conclusion: Posterior decompression with or without fusion was more effective than medical treatment in reducing the pain in patients with primary spondylodiscitis at 1 and 3 months of the follow-up period without influencing the final clinical outcome. (2021ESJ230)