Background: An optimal reconstruction of calvarial skull defects is a challenge for neurosurgeons, and the strategy used to achieve the best result remains debatable. Therefore, we conducted this study to compare the esthetic and functional outcome of custom-made three-dimensional (3D) cranioprostheses to handmade bone cement in reconstructing calvarial skull defects. Methods: We included 66 patients above 10 years of age with calvarial skull defects and undergoing reconstruction: 33 were enrolled in the custom-made 3D implants group and 33 in the handmade implants group in the period from August 2017 to December 2020 in the neurosurgery department of Fayoum University Hospital. Results: Complete success of the esthetic end-point was insignificantly higher in the custom-made 3D prostheses group based on the doctor’s and patients’ assessment (60.6% vs. 42.4%; 33.3% vs. 9.1%, P > 0.05), respectively. Complete success of the functional end-point was significantly higher in the custom-made 3D group compared to the handmade cement bone group according to the doctor’s and patients’ assessment (60.6% vs. 0%; 21.2% vs. 0%, P < 0.05). There were no late complications noted in the custom-made 3D prosthesis group, whereas 50% of the handmade bone group had late complications (P < 0.05). Full improvement of the symptoms of the “syndrome of trephined” was achieved in the 3D custom-made group compared to the handmade bone cement group (20% vs. 0%). Conclusion: Cranioplasty using three dimensional customs made PEEK prosthesis is a reliable method which saves operative time, lowers cost and provides less complications if compared with other cranioplasty techniques. Custom-made 3D cranioprostheses are better than handmade bone cement in reconstructing calvarial defects in terms of esthetic and functional outcome as well as complications.

Background: Spondylodiscitis could be considered one of the most disturbing challenges that face neurosurgeons due to variety of management strategies. The lumbar region was highly affected then dorsal region with higher percentage for lesion in L4/5 (25%) followed by T11/12 and L5/S1 (15%). In our study, we discuss the efficacy of debridement and fixation in cases of spontaneous thoracic and lumbar spondylodiscitis. Methods: This retrospective study included 40 patients with spontaneous thoracic or lumbar spondylodiscitis indicated for surgical intervention in the period from March 2019 to February 2021. All patients were subjected to thorough history taking, neurological examination, and investigations. The patients were operated on through posterior approach by debridement and posterior transpedicular screws fixation and fusion. Results: Clinical assessment early postoperative revealed 75% of cases showed full motor power and 20% showed improvement in motor power, for sensory assessment, 85% showed improvement, the mean visual analog scale (VAS) score was of 3.65 ± 0.87. After 3 months postoperatively, 95% of cases were full motor power with sensory and autonomic (sphincteric) improvement. The mean VAS score was 2.5 ± 0.68. After 6 months postoperative, the clinical assessment revealed that 95% of cases were full motor power with sensory manifestation improvement, and 95% of them were continent. The mean VAS score was 1±0.85. Culture results showed that 65% of samples were negative culture, 15% had methicillin-resistant Staphylococcus aureus, and 10% had Escherichia coli with a single case of Pseudomonas and another one of fungal (Candida albicans). Postoperative 90% of cases showed improvement in erythrocyte sedimentation rate results and 95% of cases showed improvement in C-reactive protein results. Conclusion: Management of spontaneous thoracic and lumbar spondylodiscitis by surgical debridement and posterolateral open transpedicular fixation seems to be effective and safe method despite the presence of infection. We found that the clinical condition of our patients showed significant improvement with this addressed approach.

Background: Multiple level anterior cervical discectomy and fusion (ACDF) is indicated for those who suffer from multilevel stenosis or compression of the spinal canal. It was reported that this intervention would unfortunately lead to a loss of normal cervical range of motion (CROM). Although, fewer studies have demonstrated the exact impact of the procedure on CROM. In our study, short and midterm postoperative CROM was described. Methods: Ninety patients who underwent ACDF were followed up postoperatively for at least 3 months. Active CROM was measured in all patients preoperatively and in postoperative follow-ups by cervical spine X-rays in lateral dynamic view using Cobb's angle method. Results: Unfortunately, postoperative CROM was significantly diminished. At the short-term (3 months) follow-up there was a great limitation in CROM. While an obvious increase in CROM at the midterm (6 months) follow-up was observed in flexion especially. The reduction in global ROM (calculated as preoperative global ROM -6 months postoperative ROM) was 4.1 and the reduction rate (calculated as reduction ROM divided by preoperative ROM) was 9.5%. The recovery ROM (calculated as 6 months postoperative ROM -1 month postoperative ROM) was 8.2. The recovery rate (calculated as recovery ROM divided by 1 month postoperative ROM) was 26.5%. Conclusion: Active CROM following multiple level ACDF was obviously diminished. The most affected motion after surgery was flexion. It was noticed that at the short-term follow-up CROM would be more limited while after further follow up CROM was obviously improved even in neck flexion motion.

Background: Cerebrospinal Fluid (CSF) leak is one of the most disturbing issues that face neurosurgeons. Aim of Study: The aim of this study is to illustrate the efficacy of Continuous Lumbar Drainage (CLD) as a prophylactic and therapeutic method for CSF leak with assessment of clinical outcome and early post-operative sequelae. Patients and Methods: This study was prospectively conducted on patients with traumatic or post-operative CSF leak and those susceptible for post-operative CSF leak as skull base and spinal intradural surgeries in the period from May 2015 to November 2015 at the Neurosurgery Departments of Cairo and Fayoum Universities. These patients were subjected to insertion of CLD. Results: Excellent results in 15 patients who showed cessation of CSF leak within 4 days of CLD, good results in 4 patients who showed cessation of CSF leak within 5 days of CLD and fair results only with one patient required reexploration then showed cessation of CSF leak within 5 days of CLD. Conclusion: The present analysis of the data reveals that CLD is used as a prophylactic measure and a line of treatment for CSF leak. It may be used pre, intra or post-operatively. This study recommends the use of CLD in cases with CSF leak or suspected post-operative CSF leak.

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