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: Trapped fourth ventricle (TFV) is a rare clinico-pathological syndrome, usually resulting from inflammatory conditions (post-infective and post-hemorrhagic) that may present with serious brain stem compression manifestations. Many treatment modalities have been described with varying degrees of success. Objectives: To evaluate our results in managing the trapped 4 th ventricle by inserting 4 th ventricular catheter and connecting it to the previously implanted ventriculoperitoneal (VP) shunt via Y connector. Patients and Methods: A total number of 12 cases with TFV were diagnosed and treated surgically between 2014 and 2021 by a fourth ventricular catheter and connection to the pre-existing shunt via a Y-connector. Preoperative clinical and radiological findings were reported. Postoperative improvement was evaluated during a mean follow-up of 4.3 years. Postoperative complications were reported Results: 12 patients (6 males and 6 females), with a mean age of 3.3 years diagnosed with trapped fourth ventricles were included. All patients had previous VP shunts. Headache, vomiting, abnormal movement, gait disturbance, and nystagmus were the common symptoms. Trapped fourth ventricle was post-infectious in 6 (50%) patients, posthemorrhagic in 4 (33.3%) patients, and congenital in 2 (16.7%) patients. 6 (50%) patients had preoperative slit lateral ventricles and 4 (33.3%) had multiloculated hydrocephalus. Postoperatively 10 (83.3%) patients had clinical improvement while 2 (16.7%) remained as preoperative. All patients had a decrease in the 4 th ventricular size. Complications of surgery were minor. Conclusion: Fourth ventricular shunting with a Y connector is a valuable and effective modality of treatment in TFV, especially when other methods fail or in specific complex pathological situations, with fewer complications.

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.

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