El-Gaidi, M. A., A. H. A. El-Nasr, and E. M. Eissa, "Infratentorial complications following preresection CSF diversion in children with posterior fossa tumors.", Journal of neurosurgery. Pediatrics, vol. 15, issue 1, pp. 4-11, 2015 Jan. Abstract

OBJECT: This report presents the incidence, causes, and morbidity and mortality of infratentorial complications following CSF diversion before resection in children with posterior fossa tumors.

METHODS: The medical records of 437 children admitted to Abo El-Reesh Pediatric University Hospital with a diagnosis of posterior fossa tumor between 2005 and 2012 were retrospectively reviewed. Seven children developed neurological deterioration following CSF diversion due to infratentorial complications. Computed tomography scans revealed intratumoral hemorrhage (ITH) in 5 cases, while upward transtentorial herniation (UTH), as evidenced by obliteration of the quadrigeminal and ambient cisterns, was diagnosed in 2 cases.

RESULTS: Hydrocephalus was noted in 381 patients, and 301 patients underwent CSF diversion before resection. A ventriculoperitoneal (VP) shunt was used in 214 patients, and 6 children (2.8% of shunted cases) deteriorated neurologically (4 due to ITH and 2 due to UTH). Endoscopic third ventriculostomy (ETV) was performed in 87 patients, 1 of whom developed ITH (1.1% of the patients undergoing ETV). Six patients deteriorated within 8 hours (85.7%), whereas 1 patient, the only survivor, deteriorated after 24 hours. The incidence of infratentorial complications between VP shunts and ETVs was not found to be significantly different (p = 0.659). There was a higher risk of such complications in large posterior fossa tumors (diameter ≥ 4 cm) extending close to the tentorial incisura, especially in patients with severe hydrocephalus and significant peritumoral edema.

CONCLUSIONS: Infratentorial complications (ITH and UTH) in children with posterior fossa tumors are not uncommon (2.3%) after preresection CSF diversion (VP shunt or ETV) and are associated with a very poor prognosis in most cases, even with surgical intervention.

El-Gaidi, M. A., A. H. A. El-Nasr, and E. M. Eissa, "Response.", Journal of neurosurgery. Pediatrics, vol. 15, issue 1, pp. 2-3, 2015 Jan.
Eissa, E., "The Role of telovelar approach in fourth ventricular surgery: a new perspective.", Turkish neurosurgery, 2017 Aug 31. Abstract

OBJECTIVE: Evaluation the efficiency of the telovelar approach for 4th ventricular lesions through identifying and preserving neurovascular structures.

METHODS: Forty cases of fourth ventricular tumours using the telovelar approach Results: It provides adequate exposure in all cases. The brainstem and posterior inferior cerebellar artery (PICA) were early identified and preserved in all cases. Potential tumour attachment was observed at the floor of the fourth ventricle in twenty two (55%) cases, 5 of them were brain stem glioma. 16 of the remaining 17 cases (94%) had focal attachment at any area of the caudal fourth ventricular floor and two cases (11, 7%) was attached at any area of the lateral aspect of the rostral fourth ventricular floor which was the only point of attachment in one of them. None of these tumours infiltrated the area of the cerebral aqueduct. Gross total excision was achieved in 45% of cases and near total excision was possible in 25% due to focal tumour attachment at one or more of the previously mentioned areas. However, debulking was possible in 30%.

CONCLUSIONS: The main advantage of the telovelar approach is the early identification and preservation of the brain stem and PICA and in addition it allow for assessment of potential tumour attachment at the aforementioned areas.The perspective of the telovelar approach should be directed towards the advantage of early identification and preservation of the brain stem and PICA and in addition it allow for assessment of potential tumour attachment at the aforementioned areas.

Mohi Eldin, M. M., E. M. Eissa, and H. M. Elmorsy, "Safety and Efficacy of Mini Open Transforaminal Lumbar Interbody Fusion.", Korean Journal of Spine, vol. 13, issue 4, pp. 190-195, 2016 Dec. AbstractWebsite

OBJECTIVE: Mini-transforaminal lumbar interbody fusion (Mini-TLIF) and other minimally invasive approaches introduced for the purpose of treating lumbar degenerative disc disease and instability are achieving high success and safety rates as the conventional approaches. Moreover, it has less soft tissue damage, minimal blood loss, and less hospital stay.

METHODS: A prospective study was conducted from 2012 to 2014 on 28 patients who were subjected to Mini-open TLIF combined with transpedicular screw fixation for spondylolisthesis and degenerative disc disease. Two paramedian approaches were done, 4 cm for each, to insert the pedicular screws, along with inserting unilateral TLIF cage with autologous bone graft. Decompression was done either unilateral or bilateral according to the patient side of radiculopathy. Sixteen patients (57.2%) were diagnosed with degenerative spondylolisthesis, 7 patients (25%) were diagnosed with isthmic type spondylolisthesis, and 5 patients (17.8%) were diagnosed with degenerative disc disease, 2 of them(7.1%) had previous operations at the same level. Twenty patients (71.4%) were operated at the L4/5 level, and 8 patients (28.6%) at the L5/S1 level.

RESULTS: All patients were able to ambulate the next day of surgery. The mean estimated blood loss was 251.79mL. The average hospital stay was 4.14 days. The average follow-up was 9 months. The mean visual analog scale was 1.86 at discharge, 1.68 after 3 months, and 1.38 after 6 months. After 6 months of the operation, MacNab's criteria were good in 23 patients and excellent in 5 patients. We had one case with transient weakness, 2 cases of screw malposition without clinical manifestations, and one case of infection.

CONCLUSION: Mini-TLIF approach is an efficient and safe approach for treating instability and degenerative diseases of the lumbar spine. The clinical outcome is encouraging and it may be an operation of choice for lumbar spinal fusion in selected patients.

Eissa, E. M., and M. M. Eldin, "Odontoidectomy through posterior midline approach followed by same sitting occipitocervical fixation: A cadaveric study.", Journal of craniovertebral junction & spine, vol. 8, issue 1, pp. 58-63, 2017 Jan-Mar. AbstractWebsite

OBJECT: Atlantoaxial instability with irreducible odontoid process is one of the challenges in spine surgery. These lesions are commonly treated through anterior transoral approach which is followed by posterior atlantoaxial fusion. However, there are still many limitations, especially cerebrospinal fluid fistula with subsequent life-threatening infection, difficulty in cases with limited opening of mouth due to temporomandibular arthritis or anomalies of naso-oropharynx. Türe et al. used the extreme lateral transatlas approach for the removal of odontoid. In this study, we applied the transatlas approach but through posterior midline incision aiming to evaluate its safety and feasibility.

METHODS: In four silicon injected, formalin-fixed cadaver heads, posterior removal of the odontoid was done through the familiar midline incision and subperiosteal muscle separation and elevation of muscles as on unit followed by microscopic exposure and mobilization of the vertebral artery after opening of the foramen transversarium of atlas followed by drilling of lateral mass and odontoidectomy. Occipitocervical stabilization was done between the occiput and C2, C3 (C1 lateral mass screw can be added in the contralateral side for better stabilization).

RESULTS: Unilateral excision of the lateral mass of atlas after mobilization of the vertebral artery provided safe and excellent exposure of the odontoid process in the four cadaver heads without injury to vertebral artery or retraction of the dura.

CONCLUSION: Posterior removal of the odontoid can be done safely through wide and sterile operative field, and occipitocervical fixation performed at the same sitting without need for another operation and hence avoids the risk of cord injury from repositioning.

Eissa, E. M., "Surgical experience with lateral ventricular choroid plexus papilloma in children ", International society of pediatric neurosurgeon meeting , Turkey, October 2016, 2015.
Eissa, E. M., L. I. Daker, M. M. Shaban, and M. I. Hegazy, "Lumbar puncture as a single modality for treatment of idiopathic intra cranial hypertension during pregnancy ", Egytian journal of Neurology, psychiatry and neurosurgery , vol. 53, issue 1, pp. 33-36, 2016. egyptjneurolpsychiatryneurosurg_2016_53_1_33_176367.pdf
Refaat, M. I., E. M. Eissa, and M. H. Ali, "Surgical experience of midline anterior skull base meningiomas: experience of 30 cases ", Turkish neurosurgery , vol. 25 (3), issue 25 (3), pp. 432-7, 2015. pdf_jtn_1527.pdf
ELgaidi, M. A., A. H. Abu-elnasr, and E. M. Eissa, "Response ", Journal of neurosurgery pediatric , vol. 15 (1), issue 15 (1), pp. 2-3, 2015.
ELgaidi, M. A., A. hesham abou-elnasr, and E. M. Eissa, "Infratentorial complications following preresection CSF diversion in children with posterior fossa tumors", Journal of neurosurgery pediatric , vol. 15(1), issue 15 (1), pp. 4-11, 2015. 7_peds14-146_pub_version_online_pdf.pdf
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