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Background: Cranioplasty is a reconstructive procedure to restore bone anatomy and repair skull defects. Optimum reconstruction could be a challenge for neurosurgeons, and therefore the strategy to attain the ideal result remains a subject of discussion. Aim: we aimed at comparing two completely different prostheses in reconstructing calvarial bone defects, titanium mesh and polymethyl methacrylate (PMMA) bone cement. We looked for the differences in the cosmetic and functional outcomes as well as the prosthesis-related complications. Patients and Methods: This was a randomized prospective study on the first forty successive adult patients with calvarial skull defects of different etiologies, sites and sizes admitted and operated upon at neurosurgery department, Minia University hospital between January 2017 and December 2018. We divided patients into 2 groups, Group1: 20 patients were operated upon using Titanium mesh and Group 2: 20 patients were operated upon using (PMMA) acrylic bone cement implants. Results: Regarding cosmetic appearance, functional outcome, and improvement of the clinical symptoms (syndrome of trephined), Cranioplasty using titanium mesh and acrylic bone cement proved to have nonsignificant differences in the reconstruction of calvarial skull defects of different etiologies. However, there is a statistically significant difference between both materials regarding complications especially with large skull defects (≥25 cm 2). Conclusion: there is no statistical difference between both materials regarding cosmetic and functional outcomes. However, large bone defects (≥25 cm 2) are better treated with titanium mesh due to lower incidence of complications.

neurological outcome was defined as modified Rankin Scale (mRS) £2 within 6 months clinical follow-up. Results Enrolled patients were categorized into two groups: emergent CAS (n=27) or medical treatment (n=18). Reasons for medical treatment were as follows: spontaneous neurological improvement (n=4), technical failure of emergent CAS (n=7) and good collateral circulation (n=7). Good angiographic outcome (mTICI 3 or 2b) was achieved in 25 (92.6%) patients of the emCAS group. Reocclusion (n=3) and hyperperfusion syndrome (n=3, massive intracerebral hemorrhage, cerebral edema and status epilepticus) were identified after emergent CAS. Hemorrhagic transformation was developed in 11 (40.7%) patients of the emergent CAS group and 3 (16.7%) patients of the medical treatment group (p=0.11). The emergent CAS group showed a favorable neurological outcome (51.9% vs 22.2%, p=0.07) and a low rate of recurrent ischemic stroke (p=0.01) compared to the medical treatment group. In multi-variate analysis, no early neurological deterioration before procedure (p=0.04), use of IV t-PA (p=0.03),no intracranial tandem lesion (p=0.02) and emergent CAS (p=0.01) were related with a favorable neurological outcome. Conclusions Emergent CAS for acute ischemic stroke is technically feasible and may give a chance to achieve good neurological outcome. However, physicians should pay attention to the risk of in-stent thrombosis, hemorrhagic transformation and hyperperfusion syndrome. Disclosures K. Kim: None. K. Jang: None.

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Background Unilateral non-pulsating proptosis can be caused by lesions with intraorbital extensions compressing the globe including sphenoid wing en plaque meningiomas and paranasal sinuses lesions. Patients and Methods We operated on 20 patients with unilateral non-pulsating proptosis using fronto-temporo-orbito-zygomatic (FTOZ) approach with orbital reconstruction in six patients. Eighteen patients had sphenoid wing en plaque meningioma, 1 patient had paranasal sinuses fungal infection with intraorbital and intracranial extension, and 1 patient had frontal sinus dermoid with intraorbital extension. Results Proptosis was corrected in 50% of the patients, improved in 25%, and remained stationary in 25%. Vision improved in three patients, remained stationary in three, and deteriorated in one patient. Two patients had temporary oculomotor ophthalmoplegia that resolved within 3 months. Conclusion Although it is an invasive approach, FTOZ gives excellent exposure of the orbit and anterolateral skull base that allows the excision of intracranial lesions with orbital extension. If needed, the orbit could be reconstructed easily due to excellent exposure.