Background: Gliomas represent the most frequent primary tumors of central nervous system (CNS), contributing to more than half of the incidence of brain tumors. Cancer stem cell markers (CSC) identify a group of patients at high risk for progression. Nestin is an intermediate fi lament (IF) protein was fi rst described as a neural stem cell/progenitor cell marker. Nestin-positive neuroepithelial stem cells are detected in the subventricular zone of the human adult brain and they remain mitotically active throughout adulthood. The expression of Nestin in gliomas has been suggested to be related to dedifferentiation, improved cell motility, invasive potential and increased malignancy. This study aims to investigate Nestin immunohistochemical expression in different types of glioma and its correlation with different clinicopathological parameters. Materials and Methods:Nestin immunostaining was studied in 60 specimens of glioma using avidinbiotin peroxidase method.Results: Nestin was strongly expressed in 11/60 (18.33%), moderately expressed in 29/60 (48.33%) and weekly expressed in 15/60 (25%) of studied gliomas. A signifi cant positive correlation was found between Nestin expression and histologic type (p< 0.001) and increasing grade of gliomas (p< 0.001). Conclusion:Increased Nestin expression is correlated with tumor progression, increasing grade, and poor prognostic parameter of glioma. Nestin is a useful marker for detection of CSC in high-grade glioma which is responsible for resistance to chemo-radiotherapy and may serve as a predictor for patient outcomes.

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Objective: To assess the Prognostic Factors of Extradural Heamatoma Evacuation Methodology :This study was conducted on 50 patients with extradural heamatoma 14 females and 36males, the oldest was 63 years old and the youngest was 3 years old, with mean age of 38.48 years, the cause of trauma was road traffic accident in 23 patients of them and falling from high in 14 patients of them and assault in 11 patients and animal kick in 2 patients, according to the clinical presentation the most common was manifestation of increase intracranial tension as headache and vomiting in 38 cases, followed by Loss of consciousness in 28 patients and 19 cases have typical lucid interval followed by disturbed conscious level in 12 cases, then weakness of one sideof the body in 8 cases, then unilateral dilated pupil in 5 cases followed by fits in 2 cases, while 2 cases were neurologically free and one case has bilateral dilated fixed pupil,the volume of EDH was between 20-30cc in 27 patients and between30-40cc in 17 patients and between 40-50cc in 5 patients and more than 50cc in one patient, the EDH located in temperoparietal region in 16 patients and purely in the temporal lobe in 13 patients and in the parietal lobe in 8 patients and frontoparietal in 6 patients and the frontal lobe in 3 patients and in the posterior fossa in 3 patients and biparietal in one patient ,we operate 2patients in the 1 st hour and 14 in the 2 nd and 14 in the 3 rd and 10 in the 4 th and 6 in the 5 th and 4 cases after 5 hours. RESULT: We operate 50 patients 39 of them show full recovery and 7 patients show neurological deficit and 4 patients died and no one show vegetative state and from the 46 patients who recovered 6 patients develop superficial wound infection and one patients show recollection of EDH and reoperation. Conclusion: The EDH is more common in middle aged males .As regard the site of EDH we found that the site play minimal rule in the outcome of EDH and as the most common sites was temperoparietal and temporal so mostly the middle meningial artery is the most common source of EDH and the posterior fossa is the most dangerous site as one case of the 3 patient presented with posterior fossa EDH died (33.3%) followed by temporal lobe EDH as 2(6.5%) cases from the 15 case died. the size and time from the trauma to evacuation and clinical presentation of EDH thy are the major factors that affect EDH. The clinical presentation especially the conscious level is the main factor affecting theoutcome as all the 4 cases who died the GCS was less than 8 when they arrived.

Background: Many neurovascular structures are in critical proximity to the sphenoid sinus margins. The purpose of the study is to establish a simple classification for the relation of the paraclival carotid canal to sinus margins using computed tomography to minimize surgical risks. Methods: This retrospective study included 168 patients who were referred to the Diagnostic Radiology Department for computed tomography scans on paranasal sinuses from June 2019 to June 2020. We evaluated the sphenoid sinus pneumatization pattern, the relation of the paraclival internal carotid artery canal to its margins, and the variations of the intersinus septum. Results: Type 2 canal was the commonest in the midsellar pattern, type 3 canal was the commonest in the sellar pattern whereas type 4 canal was absent in conchal, presellar, and midsellar patterns. We found a highly significant association between type 4 canal and sellar and postsellar patterns of pneumatization on both sides (p <.001). Conclusion:The establishment of a simple and applicable standard classification for the types of paraclival internal carotid artery by computed tomography can help to minimize vital surgical complications.

Background: Gliomas represent the most frequent primary tumors of central nervous system (CNS), contributing to more than half of the incidence of brain tumors. Cancer stem cell markers (CSC) identify a group of patients at high risk for progression. Nestin is an intermediate fi lament (IF) protein was fi rst described as a neural stem cell/progenitor cell marker. Nestin-positive neuroepithelial stem cells are detected in the subventricular zone of the human adult brain and they remain mitotically active throughout adulthood. The expression of Nestin in gliomas has been suggested to be related to dedifferentiation, improved cell motility, invasive potential and increased malignancy. This study aims to investigate Nestin immunohistochemical expression in different types of glioma and its correlation with different clinicopathological parameters. Materials and Methods: Nestin immunostaining was studied in 60 specimens of glioma using avidin-biotin peroxidase method. Results: Nestin was strongly expressed in 11/60 (18.33%), moderately expressed in 29/60 (48.33%) and weekly expressed in 15/60 (25%) of studied gliomas. A signifi cant positive correlation was found between Nestin expression and histologic type (p < 0.001) and increasing grade of gliomas (p < 0.001). Conclusion: Increased Nestin expression is correlated with tumor progression, increasing grade and poor prognostic parameter of glioma. Nestin is a useful marker for detection of CSC in high-grade glioma which is responsible for resistance to chemo-radiotherapy and may serve as a predictor for patient outcomes.