Objective: The characteristics of 451 Egyptian children (aged 0–14 years) with primary intracranial neoplasms were investigated for demographic, clinical, topographical and pathological features using the most recent 2007 Classification of Central Nervous System Tumors. Patients and Methods: This was a retrospective study performed in the Departments of Pediatric Neurosurgery of the Cairo University Hospitals from 2005 to 2008. Results: There was a slight male predominance (51.4%) observed in our study, and the most affected age group was 5–9 years old (43.2%). Most of the tumors were confined to a single compartment (infratentorial in 49.7%, supratentorial in 46.6%), while 3.8% of the tumors involved multiple compartments. The most common intracranial tumors were astrocytomas (35%), medulloblastomas (18.8%), craniopharyngiomas (11.3%) and ependymomas (10%). Pilocytic astrocytomas constituted 55% of all astrocytomas and 19.3% of all brain tumors, only slightly ahead of medulloblastomas. Less common types were primitive neuroectodermal tumors (2.7%), followed by meningiomas, germ cell tumors and choroid plexus tumors (2.4% each). According to the International Classification of Diseases for Oncology Coding (ICD-O-4), benign, borderline and malignant tumors constituted 7.54, 36.14 and 56.32%, respectively. Conclusion: The characteristics of pediatric intracranial tumors in Egypt are generally similar to those reported in the literature, with only minor differences.

OBJECT This report presents the incidence, causes, and morbidity and mortality of infratentorial complications following CSF diversion before resection in children with posterior fossa tumors. METHODS The medical records of 437 children admitted to Abo El-Reesh Pediatric University Hospital with a diagnosis of posterior fossa tumor between 2005 and 2012 were retrospectively reviewed. Seven children developed neurological deterioration following CSF diversion due to infratentorial complications. Computed tomography scans revealed intratumoral hemorrhage (ITH) in 5 cases, while upward transtentorial herniation (UTH), as evidenced by obliteration of the quadrigeminal and ambient cisterns, was diagnosed in 2 cases. RESULTS Hydrocephalus was noted in 381 patients, and 301 patients underwent CSF diversion before resection. A ventriculoperitoneal (VP) shunt was used in 214 patients, and 6 children (2.8% of shunted cases) deteriorated neurologically (4 due to ITH and 2 due to UTH). Endoscopic third ventriculostomy (ETV) was performed in 87 patients, 1 of whom developed ITH (1.1% of the patients undergoing ETV). Six patients deteriorated within 8 hours (85.7%), whereas 1 patient, the only survivor, deteriorated after 24 hours. The incidence of infratentorial complications between VP shunts and ETVs was not found to be significantly different (p = 0.659). There was a higher risk of such complications in large posterior fossa tumors (diameter ≥ 4 cm) extending close to the tentorial incisura, especially in patients with severe hydrocephalus and significant peritumoral edema. CONCLUSIONS Infratentorial complications (ITH and UTH) in children with posterior fossa tumors are not uncommon (2.3%) after preresection CSF diversion (VP shunt or ETV) and are associated with a very poor prognosis in most cases, even with surgical intervention.

The free-hand technique of OC screw placement is a safe and viable option for occipitocervical fixation and may be a preferred alternative in selected cases. However, further studies are needed to compare its safety and reliability to other more established methods.

Objective: To investigate the demographic, clinical, radiological, pathological and surgical features and outcomes of infantile intracranial neoplasms, the second most common neoplasm in infants. Patients and Methods: We conducted a retrospective study in the Department of Pediatric Neurosurgery at the Abo El-Reish Children’s Hospital from 2005 to 2008. Results: Out of 451 patients with primary intracranial neoplasms (age 0–14 years), 21 infants (<1 year) underwent surgery, representing 4.7% of total cases. The most common tumor was choroid plexus papilloma (23.8%), followed by teratoma (19%) then astrocytoma and ependymoma (14.3% each). Of the 21 surgical cases, 90% were intra-axial, 80% were in the supratentorial region, and 57% were intraventricular. There was only 1 case of intraoperative mortality (4.8%). Gross total excision was achieved in 65%, debulking in 30%, and biopsy in 5%. Three patients received chemotherapy, but none received radiotherapy. The statistically significant predictors of prognosis were the extent of resection and tumor grade. Conclusion: Although the prognosis for infantile intracranial neoplasms is worse than for older children, an overall promising outcome with low operative morbidity and mortality was achieved using gross total excision and appropriate adjuvant chemotherapy as part of a multidisciplinary approach.

Background Data: Axis fixation is still challenging due to intimate relation with the vertebral artery and complex topographical anatomy. Purpose: The aim of this work is to assess and compare the safety, feasibility and limitations of 3 posterior segmental axis fixation techniques (transpedicular, transpars and translaminar screws). Study Design: A retrospective anatomico-radiological study. Material and Methods: Forty axis vertebrae (27 dry bone and 13 computed tomography scans of patients who underwent axis fixation) were retrospectively studied (total 80 sides). The morphology of the pedicle, pars interarticularis and lamina were assessed bilaterally for the width (W), height (H) and screw length (L). In addition, the spino-laminar angle was measured. It was considered difficult for a conventional 3.5mm screw to be inserted safely, if any of these parameters is ≤4.5mm. Results: The mean pedicle, pars and lamina W and H were (6.0±1.5mm and 7.1±1.8mm), (9.51.6±mm and 192.5±mm) and (6.21.5±mm and 12.1±1.5mm) respectively. The mean spino-laminar angle was 45.1±4° laterally. The mean transpedicular and translaminar screw lengths were 26.8±2.2 and 23±4.1mm respectively. While the feasibility rates were 83.7% and 90% because the pedicle (W and H) and laminar (W) were ≤4.5mm respectively. All the pars measured in this study can tolerate a 14mm screw. However, when using 15mm, 16mm, 17mm and 18mm screws, the incidence of violating the vertebral artery groove was 2.5%, 6.3%, 13.8% and 23.8% respectively.