Objectives:Surgical resection of low-grade gliomas (LGGs) in eloquent areas is one of the challenges in neurosurgery, using assistant tools to facilitate effective excision with minimal postoperative neurological deficits has been previously discussed (awake craniotomy and intraoperative cortical stimulation); however, these tools could have their own limitations thus implementation of a simple and effective technique that can guide to safe excision is needed in many situations.Materials and Methods:The authors conducted a retrospective analysis of a prospectively collected data of 76 consecutive surgical cases of LGGs of these 21 cases were situated in eloquent areas. Preoperative functional magnetic resonance imaging (fMRI), pre- and post-operative MRI with volumetric analysis of the tumor size was conducted, and intraoperative determination of the craniometric points related to the tumor (navigation guided in 10 cases) were studied to evaluate the effectiveness of the aforementioned tools in safe excision of the aforementioned tumors.Results:Total-near total excision in 14 (66.67%) subtotal in 6 (28.57%), and biopsy in 1 case (4.57%). In long-term follow–up, only one case experienced persistent dysphasia.Conclusion:In spite of its simplicity, the identification of the safe anatomical landmarks guided by the preoperative fMRI is a useful technique that serves in safe excision of LGGs in eloquent areas. Such technique can replace intraoperative evoked potentials or the awake craniotomy in most of the cases. However, navigation-guided excision might be crucial in deeply seated and large tumors to allow safe and radical excision.

Background Acute Subdural hematoma is a very crucial entity in traumatic brain injury, presented with disabling morbid complications and a high mortality rate; therefore, it is a massive socio-economic burden, leading to either direct or secondary brain injury, as hypoxia. Aim and objectives Comparative study between decompressive craniotomy (DC) and craniectomy in the management of acute subdural and their consequences. Assessing the most effective management protocol for ASDH with the least morbidity, short hospital’ stay and avoidance of re-operation. Method The study design is a prospective comparative randomized study, conducted on 30 patients with ASDH operated and managed starting December 2019 inclusive April 2021 at the Neurosurgery Department Cairo University Hospitals. They were divided equally into two groups: 15 had decompressive craniectomy and another 15 cases were operated upon with craniotomy. All patients were diagnosed with traumatic ASDH. Results The mean GCS pre-operative in DC was (9.4) mean with a range from (6 to 13) and the post-operative mean was (11.13) with a range from (4 to 15) compared to the results in the craniotomy group; the pre-operative mean was (9.6) with a range from (6 to 10) and the post-operative GCS mean (11.53) ranging from (6 to 14) that had a P value of 0.69. Conclusion There is no statistical significance in comparing decompressive craniectomy and craniotomy in dealing with ASDH, yet early time of surgical evacuation and duroplasty have shown to have good prognostic factors.

Background: Craniopharyngioma is a benign tumor which represents 2% -3% of all intracranial tumors, there are two types: childhood type which affects children between 5 and 10 years and adulthood type which affects patients 50 -60 years old. The presenting symptoms develop over years and include visual, endocrine, hypothalamic, neurological and neurophysiological manifestations. Surgery is the treatment of choice. Postoperative radiotherapy, gamma-knife and intra tumoral injection of chemotherapeutic drugs have been used as an adjuvant therapy in some cases. Objectives: In this study, we evaluated the role of endoscopy in assisting microscopic surgical removal of craniopharyngioma. Methods: Eleven patients were operated upon in Cairo University Hospitals, Egypt. All operations were done using microscope through the subfrontal approach. At the end of surgery, the endoscope was used to detect any residual tumor in the subchiasmatic and retrochiasmatic areas and to visualize the posterior part of the tumor which couldn't be seen by the microscope to check if it was adherent to the hypothalamus and to evaluate whether to be removed or not. Results: The study included eleven cases, four of which were childhood type and seven adult type craniopharyngiomas. Total removal was achieved in six cases (five cases of adulthood type). Oumaya reservoir was inserted in five cases; ventriculoperitoneal shunt was needed in five cases. All cases suffered from temporary diabetes insipidus postoperatively, while only two cases developed permanent diabetes insipidus. Three cases presented preoperatively with pituitary hypofunction and two cases developed postoperative pituitary hypofunction, which necessitated hormone replacement therapy. Conclusion: Craniopharyngioma is one of the most difficult and challenging tumors for neurosurgeons due to its relation to optic nerve, hypothalamus and vascular system formed by Willis circle and its perforating branches. Endoscopy has a role in decision making after microscopic removal of craniopharyngioma.

Objective: Many approaches have been used for surgical removal of olfactory groove meningioma (OGM) as pterional, bifrontal, interhemispheric, and frontolateral approach. We evaluated the role of unilateral subfrontal approach for the removal of giant OGM "bigger than 6-cm". Patients and Methods: Nine patients with giant OGM had unilateral subfrontal approach between 1 st of January 2015 and December 2017 in Cairo University Hospitals. A retrospective study we done analyzing clinical data, neuroimaging, surgical result and extent of tumor resection. Results: Total tumor resection was achieved in seven cases "Simpson grade I and II". Subtotal resection was achieved in two cases, one case there was enchasing of the anterior cerebral artery. The other case subtotal resection was achieved due to old age of the patient. The frontal air sinus and cribriform plate and ethmoidal sinus were repaired using fat, fascia lata and vascularized pericranium flab with the use of histoacryl: One case developed hydrocephalus which required the insertion of a ventriculo-peritoneal shunt. One case developed wound infection and meningitis which required medical treatment only. There is no case of CSF leak or mortality in our series. Conclusion: The unilateral subfrontal approach is a safe and efficient approach for removal of giant olfactory groove meningioma. It combines the benefits of the bifrontal, frontolateral and pterional approach with early access to CSF drainage and early attack of the blood supply of the tumor.

Background: Spontaneous descent of the CSF (Cerebrospinal fluid) from the nose is called rhinorrhea. The causes are defects in bones of the base or meningeal tear. The surgical management is still a challenge. The surgical repair is a must to prevent the complication which could be brain abscess, meningitis, or pneumocephalus. The available surgical management is either transnasal, or transcranial. The endonasal route represents an easy access but equally aggressive alternative and of limited access. Objective: We reviewed the clinical outcomes of thirteen cases of spontaneous CSF leakage managed by transcranial intradural approach. Patients and Methods: This is a retrospective study about the records of 13 patients who underwent transcranial intradural approach as a surgical management for spontaneous CSF rhinorrhea in our department in the period between November 2017 and October 2019. Results: CSF leakage stopped after initial surgery in 12 of 13 patients, giving a success rate of 92.3%. The remaining case did not agree for new surgery and the case resolved without surgery for this patient. Postoperative complications included superficial wound infection in one patient, and anosmia in one patient. No other neurological problems were encountered over the ten-months' follow-up period. Conclusion: The transcranial route is the treatment of choice for patients with anterior cranial fossa spontaneous CSF rhinorrhea. A satisfactory surgical outcome depends on exact diagnosis, proper operative approach, and the surgeon's skills and experience.