Understanding the critical meningeal architecture in and around Meckel's cave allows experienced cranial neurosurgeons to develop a subtemporal interdural approach to dumbbell-shaped trigeminal schwannomas that effectively converts a multiple-compartment tumor into a single-compartment tumor. Dural incisions and stepwise mobilization complements our previous description of the bony dissection for this approach.

Surgical exposure of the distal cervical ICA is associated with relatively high morbidity that increases with higher levels of exposure. Staged maneuvers have been shown to increase ICA exposure, especially in our systematic approach. The number of steps required varies depending on the level of lesion. Complete understanding of the surgical anatomy is essential to minimize surgical morbidity and to develop surgical expertise.

Background Data: Degenerative lumbar spine disorders are common pathologies that usually affect females in their sixth decade or older. Patients usually present with various symptoms, including back pain, radiculopathy, or neurogenic claudication, among other less common presentations. Different fusion procedures are available to manage these problems. Purpose: This study was designed to evaluate the clinical and radiological outcome of transforaminal lumbar interbody fusion (TLIF) and posterolateral fusion (PLF) in managing degenerative lumbar disorders. Study Design: A prospective study. Patients and Methods: This study was conducted on patients with degenerative lumbar spondylolisthesis and degenerative lumbar spinal stenosis who underwent lumbar spine fixation with either TLIF or PLF. Patients were randomized into two groups according to the operative procedure: Group A (20 patients) underwent TLIF and Group B (20 patients) underwent PLF. Patients were followed up and assessed for back and leg pain, functional disability, and spinal fusion. Results: We found that both TLIF and PLF improve disability and pain in patients with degenerative lumbar disorders. TLIF was found to be superior to PLF as regards achieving radiographic outcomes. We did not find strong evidence to support the use of interbody fusion along with transpedicular fixation compared to traditional posterolateral fusion in the treatment of degenerative lumbar disorders, taking into consideration the higher material costs added with interbody fusion. Conclusion:The reported data in the present study suggest that both TLIF and PLF provide improvement of disability and pain in patients with degenerative lumbar disorders. They also suggest that TLIF is superior to PLF when comparing the achievement of radiographic fusion. However, there is no significant clinical outcome difference to recommend using TLIF over traditional PLF in treating degenerative lumbar disorders, especially with the higher treatment costs related to the use of interbody fusion. (2020ESJ217)

Background Degenerative lumbar disorders are relatively common condition that typically affects persons over the age of 50 and are more common in females. Patients typically present with a constellation of symptoms that include back pain, radiculopathy, and/or neurogenic claudication. Aim of the Work to assess the clinical and radiological outcome of Transforaminal Lumbar Interbody Fusion (TLIF) and posterolateral fusion (PLF) in the treatment of degenerative lumbar disorders. Patients and Methods a prospective study was conducted on patients with degenerative lumbar spondylolisthesis and degenerative lumbar spine stenosis who were admitted to Neurosurgical department at Ain Shams University hospital and Arab contractors medical center and underwent lumbar spine fixation with either transforaminal interbody fusion or posterolateral fusion from February 2017 to February 2019. The patients were divided into two groups according to the operative procedure done for each group. Group A (20 patients) included patients who underwent transforaminal lumbar interbody fusion. Group B (20 patients) included patients who underwent posterolateral fusion. Results We found that both TLIF and PLF provide improvement of disability and pain in patients with degenerative lumbar disorders. TLIF is superior to PLF with regard to achieving radiographic fusion. There is no strong evidence to support the use of TLIF over traditional PLF in treatment of degenerative lumbar disorders, especially with the increased material costs associated with interbody fusion. Conclusion both TLIF and PLF provide improvement of disability and pain in patients with degenerative lumbar disorders. TLIF is superior to PLF with regard to achieving radiographic fusion.

Background Recurrent disc herniation is the most common cause of reoperation after the primary disc surgery, The management of recurrent disc herniation remains somewhat controversial. Surgical treatment for recurrent disk herniation can be broadly categorized as revision discectomy alone or revision discectomy and fusion or percutaneous endoscopic interlaminar discectomy. Aim of the work to evaluate and compare the therapeutic effect between different modalities of treatment of the recurrent lumbar disc protrusion (RLDP) through 3 groups: (1) First group treated by conventional discectomy. (2) Second group treated by discectomy and lumbar fusion either by PLF, PLIF or TLIF. (3) Third group treated by percutaneous endoscopic interlaminar discectomy. Patients and methods It is a prospective cohort study performed between January 2012 and April 2017 on 150 patients complained of recurrent lumbar disc herniation. They were surgically treated at the Department of Neurosurgery, Ain Shams University Hospitals. All patients are evaluated clinically by VAS, JOA and Oswestry disability index (ODI) through follow up period of 2 years (one month, 6 months, 1 yr, 2 yrs). They were divided into 3 groups (I&II and III) each group was a fifty patients Results the mean overall recovery rate is 89%, comparison between the three groups showed significant improvement of the endoscopic group and fixation group than simple discectomy group in term of VAS LBP, leg pain , JOA and ODI. Intraoperative blood loss, length of operation and hospital stay were significant less in endoscopic group than fixation and simple discectomy group CONCLUSION Recurrent lumbar disc prolapse management is a controversial issue, there are different surgical modalities (either by open discectomy, discectomy and fixation or Percutaneous interlaminar lumbar discectomy PEILD) although those surgical modalities are successful the PEILD is the optional choice that offers less tissue trauma, rapid recovery, less cost effect and early return to work