Background: Various surgical procedures have been recommended for the treatment of lumbar spondylolisthesis, but controversy still exists regarding the optimal surgical technique. In this study, we compared the clinical and radiologic outcomes of posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) with pedicle screw fixation in the treatment of single-level lumbar spondylolisthesis. Methods: Ninety-four patients underwent lumbar interbody fusion with pedicle screw fixation for the treatment of adult lumbar spondylolisthesis. Forty-six had PLIF with two cages and pedicle fixation (group 1), and 48 had TLIF with one cage and pedicle fixation (group 2). The follow-up was performed clinically using the visual analog scale (VAS) and Oswestry Disability Index (ODI) Questionnaires. Outcome scores were assessed 3, 6, and 12 months after surgery. Radiographs were obtained postoperatively and at regular intervals for 6 months. Perioperative outcomes such as surgery time, blood loss, length of hospital stay, and incidence of surgical complications were also recorded. Results: Estimated blood loss and operative time in the TLIF group were significantly lower than those in the PLIF group. VAS for back pain and ODI were significantly better in the TLIF group than the PLIF group. However, at the time of the last follow-up, both groups had similar slip reduction and spinal fusion rates. More complication rate was encountered in the PLIF group compared to the TLIF group. Conclusions: Our study showed that TLIF is superior to PLIF with respect to functional outcome and complication rate in grade I/II single-level lumbar spondylolisthesis.

Background: Pineal tumors are uncommon tumors that affect <1% of adults, with 50% of them being germinomas. A combination of endoscopic third ventriculostomy (ETV) and tumor biopsy is usually used. Cerebral vasospasm in association with aneurysmal subarachnoid hemorrhage (aSAH) has been extensively studied. However, at least according to the research, this is not the case in intraventricular hemorrhage (IVH) cases. We present a case with two distinct findings: (1) an unexpected large IVH following the removal of an external ventricular drain (EVD) in a patient who had undergone ETV and tumor biopsy, resulting in severe clinical vasospasm and (2) incidental pineal region germinoma regression on follow-up magnetic resonance imaging (MRI) without any prior adjuvant chemoradiation to explain such regression. Case Description: The authors describe an 18-year-old male patient who had a routine, uneventful combined ETV and tumor biopsy, as well as the placement of an EVD. Histopathological examination revealed germinoma. His postoperative course was complicated by IVH after EVD removal, which resulted in clinical vasospasm. Without any prior adjuvant chemoradiation, follow-up MRI of the b rain revealed a significant reduction in the size of the germinoma as well as reconstitution of the patency of the previously obstructed aqueduct of Sylvius. Conclusion: The take-home message from this case is that in the case of postoperative clinical deterioration in a patient with concurrent IVH and ETV, a high index of suspicion for vasospasm is required, as this may allow a significant amount of blood to pass down to the basal cisterns. Early detection and management of clinical vasospasm are critical for a better neurological outcome. Furthermore, unexpected tumor size changes can occur due to a variety of factors, so recent preoperative MRI of the brain should be obtained in the lead-up to surgery, and postoperative computed tomography should be used sparingly to avoid radiation-related tumor changes.

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Background and objectives Multiple brain lesions represent a serious challenge in which biopsy is commonly the first step to help overcome patients' mental anxiety and decide the following treatment step. This study presents an effective decisional algorithm that could guide in dealing with such a challenge. We evaluate the feasibility and safety of frame-based stereotactic biopsy to obtain the histopathologic diagnosis of the multiple intra-axial brain lesions and to decide the further treatment. Patients and methods Thirty-two patients with multiple intracerebral lesions underwent stereotactic serial biopsies for brain lesions at the Neurosurgery Department, Tanta University Hospital. All the stereotactic biopsies were obtained under local anesthesia using Riechert–Mundinger (RM) system or Cosman–Roberts–Wells (CRW) system. Results The histopathological diagnosis revealed multifocal malignant gliomas in 43.75% of patients (18.75% anaplastic astrocytoma and 25% multiform glioblastoma) and metastatic tumor in 37.5% of patients (all were adenocarcinoma). In addition, 12.5% had multiple brain abscesses, and 6.25% had malignant lymphoma. We reported no mortality secondary to the surgical procedure. Conclusions Stereotactic biopsy is considered the best choice to allow histopathologic diagnosis of multiple brain lesions with minimal morbidity and no mortality. Histopathologic findings gained with stereotactic procedures guided the choice of proper treatment thus eliminating the hazards associated with blind treatments.