No abstract

Cranioplasty is a routine procedure in the practice in neurosurgery and craniofacial surgery. For the closure of the cranial defect, it may be difficult or impossible to split the bone sufficiently to obtain enough bone for complete closure of the defect in younger children. Thus, sometimes there is the need to use allografts, which may not be widely available in rural practice. We present 2 cases of cranioplasty with widely available and used polypropylene abdominal wall mesh. To add rigidity to the construct, the mesh was organized in a multilayered fashion. Postoperative follow-up showed good functional and cosmetic results.

Objectives: To evaluate the demographic characteristics, surgical safety in addition to highlighting major complications in 1525 consecutive patients who underwent microscopic inter-laminar discectomy electively at King Hussein Medical Center. Methods: A series of 1525 consecutive patients underwent elective inter-laminar lumbar discectomy, during a 5year period (January 2009 to January 2014) in our neurosurgical department, are analyzed retrospectively. Demographic features evaluated: Age, gender, site of surgery. In addition to general and specific complications encountered. Results: Lumbar discectomy surgeries operated more commonly in male patients constituted with a percent of 64 % of all lumbar discectomies considered in this study, and it was more common in the age group between 40-60 yearold patients .The most common level operated was L4/L5 level, followed by the L5/S1 level. With a recurrence rate of 4.9% in all over levels operated, unintended durotomy occurred in 7.9 % of the surgeries, superficial wound infection and deep wound infection occurred in 3%, 0.5% respectively and the mortality rate was 1/1525. Conclusion: Five-year follow-up demonstrate effective interlaminar approach in treatment of herniated lumber disc with comparable complications to reported incidences worldwide. Demographic features were in line with reported results in terms of gender and age groups and slit deference regarding level of disc herniation.

Background: Extra-axial cavernomas at the cerebellopontine angle (CPA) are rare clinical entity that can radiologically mimic several lesions encountered at this location. Case Description: A 36-year-old female patient referred to our emergency service with acute decreased level of consciousness and vomiting. Neurological examination showed Glasgow Coma Scale of 12 with downbeat nystagmus of the right eye. Brain computed tomography scan and magnetic resonance imaging showed multilobulated extra-axial mass lesion located in the right CPA. The lesion was with various signal intensities in T1- and T2-weighted images suggestive of hemorrhages of different ages. T2 gradient echo sequences showed multiple sinusoid-like channels and diffuse hemosiderin deposition. These figures were compatible with cavernous malformation. The patient was operated by retrosigmoid approach. Dissection of the mass from the trigeminal, facial, vestibulocochlear, and lower cranial nerves was performed and total resection of the tumor was achieved. Histopathological examination confirmed the diagnosis of cavernoma. Conclusion: Although CPA cavernomas are very rare, they should be considered for differential diagnosis when evaluating CPA lesions preoperatively for better intraoperative management and postoperative outcomes.

A 15-year old female patient was complaining from swelling in the left side of the neck since 3 months. Physical examination showed palpable and mobile left supraclavicular neck mass in the carotid triangle, uvula deviation to the left side and normal vocal cords position and function. Neck imagings showed well-defined, well-encapsulated left neck mass in the left carotid sheath pushing the internal jugular vein anteriorly and the common carotid artery posteriorly. The mass was extending from the level of C4 superiorly and the supraclavicular region inferiorly. Patient was operated with left anterior approach and circumferential dissection and enucleation was performed. Post-operative period was uneventful and devoid of any complications or deficits. Histopathological examination revealed Castleman disease.