Background Giant pituitary adenoma represents one of the challenging tumor for neurosurgeons. Many microsurgical approaches in the past were used for its management. Recently and with evolution of the endoscopic equipment and instruments, extended endoscopic transsphenoidal approach become one of the preferable approaches for its surgical excision. Methods We prospectively document the clinical , surgical and follow up data for all patients presented with giant pituitary adenoma to Ain-Shams university hospital and Weill Cornell Medical College, Presbyterian hospital and were surgically treated with extended transsphenoidal approach from 2015 till 2019. Results Our group study formed of 44 patients with mean age 53.03 (range 14.7-82.4) and a male predominance (59%). The main presentation was visual problems in 75% followed by partial hypopituitarism in 31.81% while headache was in 13.64%. Only 4 patients had functioning adenoma (3 prolactinoma and 1 acromegaly). Average tumor volume was 26.95 ± 17.25 cm3, while the mean maximum tumor diameter was 4.73 cm (range 4.0-8.0 cm). Radiographic invasion was found in 97.73% to suprasellar cistern, 61.36% to the cavernous sinus and in 34% to the sphenoid sinus. GTR was achieved in 45.45% with Knosp score is the only significant predictor factor for resection rate (p = 0.04). Visual improvement achieved in 75.76%. 50% (2 patient) of the patients with functioning adenoma were cured. Complications included CSF leak in 3 patients, permanent DI in 4 patients and postoperative hematoma in 2 patients. Recurrence and progression rates without upfront radiation therapy were 5.00 % and 31.81% respectively after mean follow up period 57.90 months. Conclusions Extended endoscopic approaches for achieving maximum resection with minimal morbidity for giant pituitary adenoma are very effective. Lateral tumor extension with cavernous sinus invasion represents the limiting point in achieving gross total resection. Upfront radiation therapy for patients with residual adenoma can be avoided but regular follow up should be warranted.

Background: Trigeminal neuralgia may be "classical" or "symptomatic". The term classical refers to trigeminal neuralgia (TN) of unknown cause. While the secondary or symptomatic trigeminal neuralgia is due to other causes such as tumors or demyelinating lesions. The pathogenesis of TN and the effect of the different surgical procedures are not completely understood until now. However, the neurovascular conflict theory is a cause widely accepted and can also explain other cranial rhizopathies. Treatment options for the trigeminal neuralgia include medical treatment, ablative procedures (Gasserian ganglion percutaneous techniques, gamma knife surgery) and non-ablative procedure (microvascular decompression). Microvascular decompression is associated with the most favorable outcome. Aim of the study: the study aims to evaluate the effectiveness of microvascular decompression in patients with primary trigeminal neuralgia regarding pain control, recurrence rate, and procedurerelated complications. Patients and Methods: We conducted a prospective observational study on 20 patients with primary trigeminal neuralgia, operated upon for microvascular decompression with follow up period at immediate post-operative, 6, 12 months period regarding pain control and recurrence. Results: excellent outcome with complete pain resolution has been observed in 75%, and only 5 % no pain control at immediate post-operative month follow up, there is a 5% incidence of transient facial palsy and CSF leakage. Conclusion: Although MVD surgery is an effective remedy for cranial nerve rhizopathies. Emphasis on operative skills, safety focus, and pre-plans for managing postoperative complications is critical to improving patient outcomes. As these cranial nerve hyperactivity disorders per se are not life-threatening, a safe surgery should be the priority of MVD

Background Traumatic thoracic and lumbar fractures are very common specially in the thoracolumbar junction and the most common causes are road traffic accidents and falling from height. Aim of the Work to evaluate efficacy of ligamentotaxis in thoracic and lumbar compressed and burst spine fractures using intact posterior longitudinal ligament and factors affect its outcome without anterior vertebral decompression through repositioning retropulsed segments, restoring vertebral height. Patients and Methods This study was conducted on 20 patients (with Non-propability convenience sample) with traumatic thoracic and lumbar spine fractures with intact posterior longitudinal ligament in El-maadi military hospital, Ain Shams university hospital during the period of 2017-2018. Results The most common postoperative complication was infection in 5 % of patients and CSF leakage infection in 5 % of patients. Conclusion The outcome in the study were successful in 95% of patients as reduction of retropulsed part occurred by the intact posterior longitudinal ligament.