AIM: To characterize the sociodemographic, clinical and radiological findings of patients with depressed skull fractures overlying cranial dural sinuses that we have faced in our institute. In addition, to explore the indications and choices for the surgical and nonsurgical management of such cases, and assess outcomes in these two treatment groups. MATERIAL and METHODS: We prospectively followed up a cohort of 34 patients with fractures over dural venous sinuses from January 2013 to December 2017. Twelve (35.1%) were simple depressed fractures (SDFs) and 22 (64.7%) were compound depressed fractures (CDFs). Eighteen patients (52.9%) were treated surgically, and 16 (47.1%) were treated conservatively. RESULTS: The mean age was 20.8 years. Thirty-two of the patients were males (94.12%). The mean time from trauma until hospital arrival was 3.8 hours, and the mean admission Glasgow Coma Score (GCS) was 13.7. Direct trauma was the most common mode of injury. Funduscopy was performed in 16 patients (47.1%), and magnetic resonance venography (MRV) in four patients (11.8%). Twenty-four patients (70.59%) had the fracture overlying the superior sagittal sinus (SSS). The mean length of hospital stay was five days, and the mean follow-up duration was 6.8 months. Twenty-eight patients (82.35%) had a good recovery. CONCLUSION: The majority of SDFs and some CDFs overlying dural sinuses can be managed safely without major surgical intervention. Conservation should be favored when the sinus is patent, dura intact, and bone displacement is insignificant in neurologically intact patients with an apparently clean wound. Otherwise, surgery should be considered. We also propose including a funduscopic examination and venogram as parts of the initial trauma work-up for these patients.

Background Data: Acquired degenerative lumbar canal stenosis is considered a common indication for lumbar spine surgery in old patients. The traditional approach is wide open laminectomy, medial facetectomy, and foraminotomy, which includes bilateral muscle separation and extensive excision of the posterior spinal structures. Minimal invasive surgeries as microsurgical and endoscopic have been now used for the treatment of lumbar canal stenosis during the last years. Purpose: To assess clinical outcome of unilateral approach in bilateral decompression of lumbar canal stenosis. Study Design: Observational analytic prospective study. Patients and Methods: Twenty patients with degenerative lumbar canal stenosis have undergone bilateral decompression from unilateral approach at Ain Shams university hospitals between May 2014 and April 2016. Prospective analysis of their clinical outcome was conducted. Results: In this study twelve were male (60%) and eight were female (40%). The mean age was 43.1±12.33 (range 35-55years). The duration of clinical presentation ranged from 6 to 24 months. Preoperative clinical presentation was low back pain (95%), sciatica (85%), neurogenic claudication (100%) and sensory changes (80%). Marked improvement of preoperative leg pain has been observed after surgical decompression. Significant reduction of the mean preoperative VAS (7±0.72) (over all back and leg pain) to VAS

Background Symptomatic chronic subdural hematomas (CSDH) remain one of the most encountered forms of intracranial hemorrhages particularly in the elder patients, yet fortunately implies a good surgical prognosis. Burr hole evacuation under general anesthesia is the most commonly used neurosurgical technique for the management of CSDH. Clinical disagreement between many studies regarding the number of burr holes required to achieve the optimal surgical and clinical outcome has long existed. The objective of this study is to evaluate the prognosis and clinical outcome following the use of single-burr hole craniostomy technique in the aim of surgical evacuation of CSDH. Results This is a retrospective study of 30 patients, with symptomatic unilateral or bilateral CSDH managed by the authors strictly by single-burr hole evacuation with closed-system drainage on the corresponding site of the hematoma. Clinical outcome was then assessed at 1, 7, and 30 days after surgery using the Glasgow Coma Scale (GCS) and by comparing the Markwalder grade scale before surgery to 1 month following surgery; the pre- and post-operative radiological data, clinical neurological progress and the possible incidence of complications postoperatively were also recorded. Study duration was from August 2019 to October 2020. Our study included 18 (60%) male patients and 12 (40%) female patients. The main presenting symptom was altered level of consciousness noted in 29 (96.7%) patients; a history of a relevant head trauma was recorded in 11 patients (36.7%). The GCS showed a statistically highly significant improvement comparing the preoperative to the postoperative values throughout the follow-up intervals (p = 0.001); similarly, the Markwalder score significantly improved 1 month after surgery, where 17 (63%) patients were Markwalder grade 0, 9(33.3%) patients were grade 1, a single patient (3.7%) was grade 2, and none were Markwalder grade 3. Conclusion Our study concluded that single-burr hole craniostomy with closed-system drainage for the management of symptomatic CSDH would be a sufficient approach to achieve a good surgical outcome with a low complication rate. Larger series and further studies would be yet considered with longer follow-up periods.

Background Data: Success rate of discectomy is greatly variable between surgeons due to lack of clear categorization of lumbar disc patients. Valid radiological objective criteria are required especially for patients with uncertain surgical indication to help in pre-operative patient assessment, surgical selection and research of post-operative outcomes of comparable level of pathology. MSU Classification reports size and location in three precise increments, described simply 1-2-3 and A-B-C providing clear objective classification of disc herniation resulting in excellent interexaminar reliability. Purpose To test reliability of MSU MRI classification of lumbar disc herniation in helping surgical selection and correlation with preoperative clinical presentation and postoperative clinical and functional outcome. Study Design Observational analytic retrospective study. Patients and Methods Retrospective investigations of one hundred patients who underwent lumbar discectomy at Ain Shams University between January 2014 and June 2015 in term of MSU classification. Results Only 2 patients (2%) in our series had grade 1-A. All other 98 patients had MSU grades with size 2 or 3 and/or B or C location or 2 or 3 combination of horizontal disc locations (A, B or C). Two cases of unintended durotomy occurred in MSU grade 3-AB (40%) and the other 3 cases occurred in grade 2-AB (60%). One case of CSF leak occurred in 3-AB herniated disc lesion (50%)

BackgroundCervical dystonia is the most common form of focal dystonia and is managed by multiple modalities including repeated botulinum toxin injections, in addition to medical treatment with anticholinergics, muscle relaxants, and physiotherapy. However, surgical interventions could be beneficial in otherwise refractory patients. This study aims to report our experience in the neurosurgical management of cervical dystonia and evaluate patient outcomes using reliable outcome scores for the assessment of patients with cervical dystonia and possible complications. This case series study was conducted on 19 patients with cervical dystonia of different etiologies who underwent surgical management [ten patients underwent selective peripheral denervation, five patients underwent pallidotomy, and four patients underwent bilateral globus pallidus internus (GPi) deep brain stimulation (DBS)] in the period between July 2018 and June 2021 at Ain Shams University Hospitals, Cairo, Egypt. With the assessment of surgical outcomes using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and the Tsui scale 6 months postoperatively.ResultsSurgical management of patients with cervical dystonia of either primary or secondary etiology was associated with significant improvement in head and neck postures after 6 months without major complications associated with the different surgical procedures. The mean improvement in total TWSTRS and Tsui scores were 51.2% and 64.8%, respectively, compared with preoperative scores, while the mean improvement in the TWSTRS subscales (severity, disability, and pain) were 40.2%, 66.9%, and 58.3%, respectively.ConclusionCervical dystonia patients in whom non-surgical options have failed to alleviate their symptoms can be managed surgically leading to significant improvements with minimal adverse effects. However, surgical treatment should be tailored according to several factors including but not limited to the etiology, pattern of dystonic activity, and comorbidities. Therefore, management should be tailored to achieve long-term improvement with minimal risk of complications.