Background: Thoracolumbar spine fractures are common injuries that can result in significant disability, deformity and neurological deficit. Injuries to thoracolumbar spine are usually the result of high-energy blunt trauma. Majority of thoracolumbar spine fractures occur due to falls from a height and motor vehicle injuries. The AO Spine thoracolumbar spine injury classification system separates fractures into three major types: type A-compression injuries; type B-tension band injuries and type C-translational injuries. Type A and B injuries are further subdivided into five and three subtypes, respectively. Next the neurologic status of the patient is evaluated and classified: N0-neurologically intact patient; N1resolved transient neurological symptoms; N2-persistent radicular symptoms; N3-incomplete spinal cord injury or cauda equina injury; N4-complete spinal cord injury and NX-neurologic exam is unobtainable. Objectives: This study applied AO Spine classification system on patients with traumatic thoracolumbar spine fractures referred to Benha University Hospitals and clarifying its role on management, decision making and outcome of those patients. Methods: This prospective study was conducted to apply AO Spine injury classification system on patients with traumatic thoracolumbar spine fractures referred to Benha University Hospitals and was utilized to describe each spine fracture and to aid decision making and management of those patients. For one year between April 2021 and April 2022, 92 selected patients referred to Benha University Hospitals with acute traumatic thoracolumbar spine fractures were included in this study. Those patients were categorized into two groups according to their management either conservative or surgical based on AO Spine injury score. Results: The majority of the patients had no associated trauma to other systems rather than thoracolumbar fractures. L1 level was found to be the most common neurological level on admission detected in 36 cases (39.1%) then L2 level in 14 cases (15.2%). Back pain was the main presentation in thoracolumbar spine fractures that improved in clinical follow up. About 80% of patients were neurologically intact. A1 was the most common fracture description according to AO Spine classification on admission detected in 28 cases (30.4%) followed by A3 in 16 cases (17.4%) and B2 in 15 cases (16.3%). N0 was the most common neurological description according to AO Spine classification on admission detected in 59 cases (64.1%) followed by N3 in 16 cases (17.4%) and N2 in 10 cases (10.9%). The mean AO Spine Classification score was 4.2. About one third of patients (33.7%) were treated surgically and two thirds of patients (66.3%) were treated conservative according to AO Spine Classification Score. There was no change in decision making from conservative cases to surgical cases. The Mean of angle of kyphosis improved and decreased from 12.2 to 11.4 during follow up. About 95.5% of patients had minimal disability on 6 th month follow up. Conclusion: The AO Spine t...

Background: Hydrocephalus is defined as an inappropriate increased pressure of cerebrospinal fluid (CSF) within the intracranial spaces with an inappropriate amount of CSF. Endoscopic third ventriculostomy (ETV) is considered an effective procedure that is safe. Purpose: The aim of the current work was to detect the factors those predict success parameters in selecting patients with idiopathic obstructive hydrocephalus as candidates for the ETV procedure at a pediatric age. Patients and methods: A clinical prospective cohort study was conducted at Benha University Hospitals from September 2018 to July 2021. A total of 61 patients with inclusion criteria of idiopathic (congenital) obstructive hydrocephalus of pediatric age (under 18 years old) with and without previous ventriculoperitoneal (VP) shunt insertion were included according to calculated sample size who undergoing ETV with a follow-up period of 6-12 months. All patients were evaluated by pre and post-operative operative MRI CSF flowmetry.Results: Sixty-one patients were operated on, with age ranged from 3 to 120 months, and the median (IQR) was 13.0 (5.5-24). Previous VP shunting was done in 15 patients (24.6%). According to the receiving operator characteristic (ROC) curve, the cut off point for ETV success age was 11.5 months; while the cut off point for ETV success score (ETVSS) was 70. MRI CSF flowmetry detected and measured the size of the ventriculostomy stoma and evaluated the flow direction and stroke volume. Conclusions: It could be concluded that endoscopy has reliable validity and safety in the treatment of idiopathic obstructive hydrocephalus. ETV success predictors are patients' age above 11.5 months and ETVSS ≥70, led to increase validity of endoscopy. MRI CSF flowmetry is safe and accurate method for evaluation of the ventriculostomy stoma.

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Background: Calvarium could be a target site for either primary or secondary tumors. Calvarial tumors present usually as painless palpable masses, which are asymptomatic neurologically. Objective: To perform a retrospective analysis of the calvarial lesions operated in our departments of neurosurgery. Patients and Methods: We retrospectively reviewed 41 consecutive patients operated for calvarial masses between 2014 and 2020 at Benha University Hospital and Merciful Brothers Hospital Trier. Clinical data were retrospectively analyzed. The diagnosis was confirmed by the histopathological examination. Results: Calvarial lesions included in this series were divided into 3 categories: tumorlike lesions, primary, and secondary tumors. The group of tumor-like lesions involved eosinophilic granuloma (3 patients), epidermoid cyst (3 patients), and fibrous dysplasia (5 patients). The primary tumors included hemangiomas (5 patients), osteomas (5 patients), and meningiomas (11 patients). Nine patients had metastasis. Calvarial lesions mostly presented with local swelling, sometimes local pain and rarely neurologic deficit. En-bloc resection was performed followed by cranioplasty. Pain was improved postoperatively in cases presented with painful swelling. The only postoperative complication was one case of wound infection. Conclusion: Although a thorough preoperative radiological evaluation in cases of calvarial lesions could be helpful in narrowing the diagnosis spectrum of differential diagnosis, en-bloc resection followed by cranioplasty could be considered as a valuable treatment option. The next step in treatment of such patients vary widely according to the histopathological findings.

Background: In the surgical treatment of disorders of the subaxial cervical spine, posterior cervical fixation procedures are routine. The posterior cervical spine is often fixed with lateral mass screws. It is regarded an ideal strategy for cervical stability repair following posterior cervical decompression. The aim of the study was to evaluate the efficacy of the free hand technique defining the optimum trajectory to insert safely lateral mass screws into the cervical spine. Patients and methods: A total of 30 patients with cervical canal stenosis and multiple disc prolapse were operated on in Benha university hospitals with 172 lateral mass screws inserted using the freehand technique through a midline posterior approach. Post-operative clinical assessment as well as CT scans were utilized to evaluate how well the freehand method worked and whether it was safe to use. Results: One hundred seventy-two screws were inserted in 30 patients with an average of 6 screws per case. After the surgery, a CT scan was performed to check the screw placement and trajectory. 172 screws inserted easily and correctly with no complications while 8 screws were failed to be inserted because of a violation of the lateral mass during the insertion. No vascular or neurological complications were encountered in the postoperative period or the follow-up period. Conclusion: The freehand technique is a safe and reliable surgical technique to insert lateral mass screws with a very good post-operative purchase and a high level of safety and feasibility. Neurovascular complications are usually avoidable when using this trajectory.