Background Data: Cauda equina syndrome (CES) is a rare situation and is one of the few surgical emergencies in neurosurgery. While L4-L5 disc is the most common cause of CES, ependymoma and schwannoma are the most common tumors affecting cauda equina. Purpose: To present our experience and outcome of management of cauda equina tumors. Study Design: A retrospective clinical case study. Patients and Methods: We operated upon 22 cases with known cauda equina tumors at our institution in the period between October 2016 and April 2020. All patients were subjected to detailed general, neurological, and radiological evaluation both preoperatively and postoperatively according to our follow-up protocol. Moreover, the modified McCormick scale (MMS) has been used for pre-and postoperative functional evaluation. Patients underwent operation using the posterior midline approach, with neuromonitoring applied in 50% of patients. Results: The mean age was 44 ± 12.5 years. Nine (41%) patients were female and 13 (59%) were male. Ninety-one percent of patients presented with radiculopathy. Fifty percent of cases presented with schwannoma. Growth total tumor resection was achieved in 20 cases (91%). The last follow-up showed marked improvement in radiculopathy, motor power deficit, and MMS compared to preoperative values. Immediate postoperative motor power deterioration was reported in two cases. Recurrence was reported in one case of ependymoma at a two-year follow-up visit that underwent operation with no further recurrence after 1-year follow-up. Conclusion:The data of this study may suggest that most cauda equina tumors are benign and favorable outcome could be achieved in small-sized lesions with a short history and good preoperative clinical status. (2020ESJ220)

Background Data: Foramen magnum (FM) meningiomas are always considered challenging cases for neurosurgeons. The challenge is even heftier with early experience with limited access to up-todate neurosurgical gadgets. Besides the anatomical complexity of the region, FM meningiomas tend to grow in proximity to eloquent structures making the task even tougher. Multiple approaches have been advocated to manage these lesions; nevertheless, adopting an approach according to your experience and circumstances would be best. Purpose: To present our experience with 16 cases of FM meningiomas operated via posterior suboccipital approach and discuss the validity of this approach. Study Design: A retrospective cohort study. Patients and Methods: We reviewed our hospital records for patients where the posterior suboccipital approach was performed for foramen magnum meningiomas in the period between November 2014 and January 2019 at our institution. Lesions with anterior location or limited posterolateral extension and those with vertebral artery encasement were excluded. We could trace 16 patients with FM meningiomas operated upon using the midline suboccipital approach. Patients' imaging included IV gadoliniumenhanced MRI brain and CT angiography including brain and neck for diagnostic and planning purposes. Recorded outcome variables were pre-and postoperative Japanese Orthopedic Association (JAO) scale, extent of tumor excision according to Simpson's grading, operative blood loss, duration of surgery, hospital stay, and perioperative complications. Follow-up data were recorded from our outpatient clinic chart records. Results: Twelve patients were females and 4 were males with a mean age of 40.64±8.69 years (range, 29-56 years). The mean preoperative JOA score improved from 14.875±1.690 to 15.63±0.99 at the last postoperative follow-up. Total resection was achieved in 10 cases (6, grade I; 4, grade II), subtotal resection in 4 patients, and partial resection in 2 patients. Patients with residual lesions (N=6) were

Background The surgery of giant intracranial meningiomas (GIM) is difficult due to its large size, prominent vascularity, including and limiting visualization of various neurovascular structures, and severe cerebral edema. In this study, we will evaluate the surgical outcome of giant meningiomas according to our experience at our hospital in management of giant intracranial meningioma. Main body A retrospective analysis of 48 patients with histologically proven meningioma (≥ 6-cm diameter) who underwent surgical treatment at Benha University hospitals over a period of 5 years (June 2014/June 2019) is presented. Details regarding clinical presentation, imaging findings, surgical results and complications, and follow-up status were collected. The study group was composed of 41 females and 7 males. The age of the study group ranged from 38 to 69 years with an average of 49 years. The mean follow-up period was 36 months. Different approaches were used according to tumor location with the aim of gross total removal. Gross total removal was achieved in 90% of cases (43 cases). There were 2 cases with intraoperative complications not related to surgery. Recurrence was present in 4 cases. Mortality in this series was 4% (2 cases) with no reported intraoperative mortality. Conclusion Management of giant intracranial meningioma is a relatively common practice in neurosurgical centers in developing countries with the aim of radical total surgical removal being the first and most optimum option. Large size makes surgery difficult, but young age, meticulous surgical techniques, proper localization, trying to minimize operative time, and Simpson grade are of special value. Interdisciplinary cooperation is essential to avoid the common complications like pulmonary embolism (PE), postoperative hematoma in tumor bed that leads to bad surgical outcome.

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