Background: Atypical meningiomas differ from Grade I meningiomas in aspects of the higher rate of recurrence, more postoperative complications, and shorter life expectancy postoperatively. Objective: This study was aimed to evaluate the clinical course of atypical meningioma and prognostic factors affecting its surgical outcomes. Patients and Method: This retrospective study investigated the medical records of 45 patients who had surgical removal of atypical meningiomas at Benha University Hospitals between January 2010 and December 2021. Patients average age was (56.69± 11.11) ranged from 29 to 74 years. The follow-up period was 60 months. Analysis included multiple factors such as patient age, gender, tumor size, location, and the extent of surgical resection based on (Simpson Grading System). Results: There was significant relationship between recurrence and Simpson grade, size, and side. There was a significant relationship between rate of recurrence and type of radiation used. The mean survival time was significantly longer in Gamma knife group compared to radiotherapy. Rate of mortality was significantly higher in group radiotherapy compared to gamma knife with hazard ratio (95% CI) (5.33(0.79-36.75%). Rate of recurrence was significantly higher in group radiotherapy compared to gamma knife with hazard ratio (95% CI) (3.03(0.89-10.31%). Conclusion:It could be concluded that atypical meningiomas in elderly patients with a large size especially more than 60cc, incomplete surgical resection; frequently have poorer prognosis following surgical intervention. Postoperative radiotherapy could provide accepted local tumor control in patients with incompletely resected atypical meningioma.

Background: Occipital neuralgia associated with migraine or cervicogenic headache is not uncommon clinical syndrome. It's still a debatable issue regarding the pathogenesis and treatment options in the literature. Objective: It was to study and analyze the rule of microsurgical decompression of C2 nerve and it's ganglion in management of intractable occipital neuralgia with migraine. Patients and Methods: Thirty-six patients with this syndrome had been subjected to full clinical assessment to fulfill the clinical criteria of having occipital neuralgia with migraine (cervicogenic headache). All patients were subjected to image guided C2 ganglion anesthetic block and corticosteroid administration as a therapeutic test. Results: Among the 10 patients who had surgery and during a mean full up period of 28.1 months, 6 patients 60% (7 sides) were totally free of pain. Three patients (30%) showed moderate degree of improvement with less frequent attacks and controlled with minor medication. Only one patient (10%) showed no improvement but still without worsening of his preoperative symptoms. In nine patients (90%) the main pathology was vascular compression by vertebral venous plexus around the root and ganglion, while in six (60%) patients we found the hypertrophied dorsal atlanto-epistrophic ligament is the main pathology. Osteoarthritic sharp lower border of C1 vertebrae and lateral mass were found in three patients (30%). Conclusion: Good selection of patients with typical clinical presentation together with C2 ganglion anesthetic block were the key of success of microsurgical decompression of C2 nerve and ganglion as a valid treatment option in intractable occipital neuralgia with migraine.

Background With improvement of health care in last decades, the age of general population increased. As the elderly with degenerative lumbar disease needs to remain physically active for more years, lumbar decompression surgery with instrumented fusion is further considered and is gaining wide acceptance as it provides good results with relative minimal risk. This study aim to evaluate the safety and efficacy of lumbar decompression with instrumented fusion in elderly Results This is a prospective non-randomized clinical study conducted from July 2014 to July 2019. The included patients had chronic low back pain, radiculopathy, and/or neurogenic claudication due to degenerative lumbar disease with failed conservative management. They underwent lumbar decompression with instrumented posterolateral fusion. All patients were at least 55 years old at time of surgery and were clinically assessed as regard perioperative risk and morbidity, besides assessment of pre- and postoperative visual analog score (VAS) and Oswestry Disability Index (ODI). Data was collected and analyzed. Thirty-five patients were included in this study with mean age of 63 years. All patients presented with back pain, 77.1% with radiculopathy, and 60% with neurogenic claudication. Preoperative comorbidity was present in 60% of cases, where hypertension, diabetes, and cardiac troubles were 31.4%, 31.4%, and 14.3% respectively. The average operated level was 3.1. The complication rate was 11.4% with 2 cases with dural tear (5.7%), 2 cases with CSF leakage (5.7%), 1 case with wound seroma (2.8%), and 1 case with wound infection. Postoperative new comorbidity occurred in 5 cases (14.3%). Visual analog score (VAS) and Oswestry disability index (ODI) were recorded preoperatively and 18 months postoperatively; as regards pain, VAS improved significantly from 7.8 ± 0.87 to 1.8 ± 1.04 (P value< 0.00001), and ODI improved significantly from 58.1 ± 11 to 17.5 ± 8.3 (P value< 0.00001). Conclusion Lumbar decompression surgery with posterolateral instrumented fusion is a safe and effective surgery in elderly, as it provides significant results and gives them a chance for better quality of life. Preoperative comorbidity could be dealt with, and it should not be considered as a contraindication for surgery in this age group.

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