Background: cervical spondylotic myelopathy is a common health problem that neurosurgeons face in Egypt. The aim of this study is to evaluate the efficacy of PEEK cage only in 4 levels anterior cervical discectomy as one of surgical option other than anterior cervical corpectomy, fixation by plat or posterior approach for cervical laminectomy, and assessment of post spinal surgery pain. Methods: this prospective study on 28 patients with cervical spondylotic myelopathy (CSM) over a period of 3 years (between April 2012 and April 2015) with mean period of follow up 30 months. We have done anterior cervical discectomy with fixation by cage only for all cases with perioperative assessment and scoring clinically and radiologically (Japanese Orthopaedic Association [JOA] scores, Visual Analogue Scale [VAS] scores for assessment of neck and arm pain, perioperative parameters (hospital stay, blood loss, operative time), the European Myelopathy Scoring (EMS) and Odom's criteria, and the incidence of complication,post spinal surgery pain assessment). Results: clinical outcome was excellent (28.55), good (50%) and fair (21.5) according to Odom criteria. The European Myelopathy Scoring (EMS), improved from 10 to 16. The mean JOA score improved from 10.1 ± 2.1 to 14.2 ± 2.3. Fusion failure had been seen in 4 patients in one level for each secondary to anterior displacement of the cage with no other major complications. Conclusion: 4 levels anterior cervical discectomy with PEEK cage only is an effective, save and less costly with less post operative complication and hospital stay and less post spinal surgery pain.

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Background: Hydrocephalus in infancy is usually treated with a ventriculo-peritoneal (VP) shunt, however, endoscopic third ventriculostomy (ETV) is a recent surgical option of treatment which if succeeded, avoids shunt insertion complications. Aim of the work: to analyze the OUTCOME of ETV as a treatment for hydrocephalus in infants aged less than 1 year. Patients and methods: An analytical prospective study conducted on 40 infants suffering from obstructive hydrocephalus (28 infants with congenital aqueductal stenosis and 12 infants with post meningitic hydrocephalus) in infants younger than one year of age treated via ETV approach in Al Azhar university hospitals in the period September 2017 to September 2020. Follow up of patients done clinically and radiologically over 6 months. Results: The clinical success rate in our study was achieved in 22 cases (55%) while failure was encountered in the remaining 18 cases (45%) When comparing successful and failed cases, no significant difference was detected between the two groups regarding patient age (p = 0.095). Conversely, it was evident that the prevalence of post-meningitic stenosis was significantly more common in the failed group (44.44% vs. 18.18% in the successful group -p < 0.001). Success rates were significantly different in infants with aqueductal stenosis 18case (81.82%). Conclusion:ETV can be the definitive treatment for obstructive hydrocephalus with different etiologies in infants less than one year of age. Success rate of ETV depends not only on the age but mainly on the cause of hydrocephalus, preoperative MRI findings and surgeon endoscopic experience.

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Background Spontaneous, nontraumatic intracerebral hemorrhage (ICH) remains a significant cause of morbidity and mortality throughout the world. Although ICH has traditionally lagged behind ischemic stroke and aneurysmal subarachnoid hemorrhage in terms of evidence from clinical trials to guide management, the past decade has seen a dramatic increase in studies of ICH intervention. Aimof study The aim of the study is to assess the benefits of surgical evacuation of spontaneous ICH and the factors affecting the outcome. Patients and methods The presented study includes 30 patients with spontaneous hypertensive ICH who had surgical evacuation in Al-Azhar University Hospitals and Matarya Teaching Hospital. A history and examination, including an assessment of the baseline level of consciousness by the Glasgow coma scale (GCS) and of the neurological status, were obtained at the time of admission. The time of onset of symptoms was determined on the basis of interview of the patient, family, and witnesses. Results There is a statistically highly significant relationship between GCS on admission (preoperative) and outcome (P=0.002, highly significant). GCS preoperative is significantly correlated with GCS postoperative, that is the better the GCS preoperative is, the better the GCS postoperative would be. There is a statistically highly significant relationship between volume of hematoma and outcome (P=0.01, highly significant). No statistically significant difference was detected between the outcome of cases with residual hematoma volume (≤20 ml) after surgical evacuation and cases with total hematoma evacuation (P=0.81, nonsignificant). No statistically significant difference was detected between the outcome of the diabetic and nondiabetic patients (P=0.86, nonsignificant). The best surgical results were obtained in patients who present early, with a hematoma size of 30–60 ml, and in patients with a GCS of above 10. Conclusion Spontaneous ICH is a treatable condition provided that the patients receive appropriate care from trained staff to deal with such cases. The best candidates for ICH evacuation are those with hematoma volume 30–60 ml and GCS more than 10.