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A
A.M.Ezzat, A., M. A.R.Soliman, A. A.Hasanain, M. A.Thabit, H. E. Shitany, H. Kandel, S. H. Abdel-Bari, A. M. F. Ghoul, A. Abdullah, M. F. M. Alsawy, et al., "Migration of the Distal Catheter of Ventriculoperitoneal Shunts in Pediatric Age Group: Case Series", World Neurosurgery , vol. 119, issue November 2018, pp. e131-e137, 2018.
AA, H., A. A, A. MFM, S. MAR, G. AA, E. R, and E. AAM, "Incidence of and Causes for Ventriculoperitoneal Shunt Failure in Children Younger Than 2 Years: A Systematic Review", J Neurol Surg A Cent Eur Neurosurg., issue Decemeber 2018, 2018.
Aguirre, A. O., M. A. R. Soliman, N. J. Minissale, P. K. Jowdy, C. C. Kuo, A. Khan, R. M. Hess, D. E. Smolar, B. I. Woods, M. S. Eskander, et al., "Outcomes of 2-Level Versus 3- or 4-Level Anterior Cervical Discectomy and Fusion Using a Biomimetic Surface Titanium Cage: Multicenter Experience.", World neurosurgery, 2023. Abstract

OBJECTIVE: Interbody cages for spinal fusions are primarily constructed from polyetheretherketone or titanium compositions. However, these crude macroscopic materials pose limitations for improving the rates of bony fusions. The authors aimed to compare the fusion rates and postoperative complications in patients who underwent 2-level or 3-or 4-level anterior cervical discectomy and fusion (ACDF) performed with the use of a novel biomimetic surface titanium cage.

METHODS: A retrospective multicenter study was conducted that included all patients who underwent multilevel ACDF with this cage between January 2017 and April 2021. Patient demographics and procedure-related, radiographic, and postoperative complication data were collected.

RESULTS: A total of 124 patients were identified; 69 (55.6%) had a 3-or 4-level fusion and 55 (44.4%) had a 2-level fusion. The demographics of the 2 groups differed significantly only in terms of age (P = 0.01). At 3 months, a significantly higher solid fusion rate was found for 2-level fusions than 3-or 4-level fusions (83.7% vs. 56.3%, P = 0.004); however, significance was lost at 6-months (98.2% vs. 88.4%, respectively; P = 0.08). No patients required posterior supplemental fixation. Transient dysphagia was the only postoperative complication that was significantly increased in the 3-or 4-level fusion group compared to the 2-level group (27.5% vs. 9.1%, P = 0.02).

CONCLUSIONS: Radiographic and clinical outcomes were equivalent in 3-or 4-level and 2-level ACDFs in which these biomimetic surface titanium cages were used. Furthermore, the use of this technology led to high fusion rates with no requirement for posterior supplemental fusions.

Aguirre, A. O., M. A. R. Soliman, A. K. Ghaith, C. C. Kuo, N. Ruggiero, S. Azmy, W. Mualem, A. Khan, P. K. Jowdy, M. T. Neal, et al., "Predictive Factors of Intraoperative and Early Postoperative Outcome Measures After Anterior Lumbar Interbody Fusions Based on American Society of Anesthesiologists Score.", World neurosurgery, 2023. Abstract

OBJECTIVE: Anterior lumbar interbody fusion (ALIF) is a surgical treatment that requires a close operative plane to the great vessels, which increases the risk of perioperative complications. To our knowledge, no previous study has investigated the American Society of Anesthesiologists (ASA) Physical Status Classification System as a predictive factor for unfavorable perioperative outcomes in ALIF procedures. We aimed to analyze the ASA score as a predictive factor of intraoperative and postoperative outcomes in patients undergoing ALIFs.

METHODS: A retrospective chart review was completed at each center to identify a consecutive set of patients who underwent an ALIF. Univariate and multivariate analyses between patients with preoperative ASA scores of ≤2 and >2 were performed to identify predictive factors that may contribute to adverse intraoperative and early postoperative outcomes.

RESULTS: Among 210 patients identified, 59 (28.1%) had an ASA score >2 and 151 (71.9%) had an ASA score ≤2. On multivariate analysis, an ASA score >2 was predictive of increased 90-day reoperations (P = 0.02), estimated blood loss (EBL) (P = 0.02), and operative time (P = 0.02). Previous lumbar surgery was predictive of increased length of stay (P = 0.005), EBL (P < 0.001), 90-day readmission (P = 0.02), and operative time (P < 0.001). Posterior supplemental fixation was predictive of increased length of stay (P = 0.04). Increased number of operative levels was predictive of increased EBL (P < 0.001) and operative time (P < 0.001). Perioperative anticoagulation use was predictive of increased EBL (P < 0.001) CONCLUSIONS: Increased ASA scores were associated with unfavorable outcomes after ALIF and also can be used as a predictive tool for the risk of reoperations.

Aguirre, A. O., M. A. R. Soliman, S. Azmy, A. Khan, P. K. Jowdy, J. P. Mullin, and J. Pollina, "Incidence of major and minor vascular injuries during lateral access lumbar interbody fusion procedures: a retrospective comparative study and systematic literature review.", Neurosurgical review, vol. 45, issue 2, pp. 1275-1289, 2022. Abstract

During lateral lumbar fusion, the trajectory of implant insertion approaches the great vessels anteriorly and the segmental arteries posteriorly, which carries the risk of vascular complications. We aimed to analyze vascular injuries for potential differences between oblique lateral interbody fusion (OLIF) and lateral lumbar interbody fusion (LLIF) procedures at our institution. This was coupled with a systematic literature review of vascular complications associated with lateral lumbar fusions. A retrospective chart review was completed to identify consecutive patients who underwent lateral access fusions. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used for the systematic review with the search terms "vascular injury" and "lateral lumbar surgery." Of 260 procedures performed at our institution, 211 (81.2%) patients underwent an LLIF and 49 (18.8%) underwent an OLIF. There were no major vascular complications in either group in this comparative study, but there were four (1.5%) minor vascular injuries (2 LLIF, 0.95%; 2 OLIF, 4.1%). Patients who experienced vascular injury experienced a greater amount of blood loss than those who did not (227.5 ± 147.28 vs. 59.32 ± 68.30 ml) (p = 0.11). In our systematic review of 63 articles, major vascular injury occurred in 0-15.4% and minor vascular injury occurred in 0-6% of lateral lumbar fusions. The systematic review and comparative study demonstrate an increased rate of vascular injury in OLIF when compared to LLIF. However, vascular injuries in either procedure are rare, and this study aids previous literature to support the safety of both approaches.

Aguirre, A. O., M. A. R. Soliman, C. C. Kuo, N. Ruggiero, J. Im, Y. Chintaluru, A. M. A. Khan, A. Khan, R. M. Hess, K. Rho, et al., "Cervical Vertebral Bone Quality Score Independently Predicts Distal Junctional Kyphosis After Posterior Cervical Fusion.", Neurosurgery, vol. 94, issue 3, pp. 461-469, 2024. Abstract

BACKGROUND AND OBJECTIVE: Posterior cervical fusion is the surgery of choice when fusing long segments of the cervical spine. However, because of the limited presence of this pathology, there is a paucity of data in the literature about the postoperative complications of distal junctional kyphosis (DJK). We aimed to identify and report potential associations between the preoperative cervical vertebral bone quality (C-VBQ) score and the occurrence of DJK after posterior cervical fusion.

METHODS: The authors retrospectively reviewed records of patients who underwent posterior cervical fusion at a single hospital between June 1, 2010, and May 31, 2020. Patient data were screened to include patients who were >18 years old, had baseline MRI, had baseline standing cervical X-ray, had immediate postoperative standing cervical X-ray, and had clinical and radiographic follow-ups of >1 year, including a standing cervical X-ray at least 1 year postoperatively. Univariate analysis was completed between DJK and non-DJK groups, with multivariate regression completed for relevant clinical variables. Simple linear regression was completed to analyze correlation between the C-VBQ score and total degrees of kyphosis angle change.

RESULTS: Ninety-three patients were identified, of whom 19 (20.4%) had DJK and 74 (79.6%) did not. The DJK group had a significantly higher C-VBQ score than the non-DJK group (2.97 ± 0.40 vs 2.26 ± 0.46; P < .001). A significant, positive correlation was found between the C-VBQ score and the total degrees of kyphosis angle change (r 2 = 0.26; P < .001). On multivariate analysis, the C-VBQ score independently predicted DJK (odds ratio, 1.46; 95% CI, 1.27-1.67; P < .001).

CONCLUSION: We found that the C-VBQ score was an independent predictive factor of DJK after posterior cervical fusion.

Ali, A., and M. A. R. Soliman, "Post-aneurysmal Subarachnoid Hemorrhage Vasospasm, Clinical Correlation Between The Aneurysm Site and Clinical Vasospasm", Open Journal of Modern Neurosurgery, vol. 8, issue July 2018, pp. 306-314, 2018.
Almahdy, R. A., M. Wahid, A. A. A. Elkader, M. Lotfy, and M. A. R. Soliman, "The Utility of Multimodal Intraoperative Neuromonitoring in Spine Surgery: Case Series from a Lower-Middle-Income Country Perspective.", World neurosurgery, vol. 152, pp. e220-e226, 2021. Abstract

OBJECTIVE: Multimodal intraoperative neuromonitoring (IOM) using somatosensory-evoked potentials and motor-evoked potentials is a sensitive and specific tool for detecting intraoperative neurologic injury during spine surgery. This study aimed to evaluate the use of multimodal IOM in a lower-middle-income country (LMIC) during cervical and thoracic spine surgery in order to prevent and predict new postoperative neurologic deficits early on. This is the first report of multimodal IOM application in LMICs.

METHODS: The neurophysiologist raised the cutoff warning criteria of 50 patients who underwent surgery for different cervical and thoracic pathologies to decrease postoperative neurologic deficits. We retrospectively reviewed the medical charts and neuromonitoring traces of these patients followed by calculating the sensitivity, specificity, positive predictive value, and negative predictive value of combined IOM for postoperative neurologic deficit occurrence.

RESULTS: A significant relationship was found between the reversibility of alerts and the development of new postoperative deficits (P < 0.001). There was no relationship between the cause of alerts and the reversibility of those alerts after corrective measures were carried out (P = 0.455), or the frequency of alerts and the development of new deficits postoperatively (P = 0.578). Sensitivity, specificity, positive predictive value, and negative predictive value of combined somatosensory-evoked potential and motor-evoked potential monitoring were 100%, 80%, 62.5%, and 100%, respectively.

CONCLUSION: Because of the limited experience and the many technical difficulties faced in LMICs, we found that this cutoff limit resulted in more false-positive warnings but helped to avoid any false-negative results, thus enhancing the safety of surgery.

Almahdy, R. A., M. Wahid, A. A. A. Elkader, M. Lotfy, and M. A. R. Soliman, "The Utility of Multimodal Intraoperative Neuromonitoring in Spine Surgery: Case Series from a Lower-Middle-Income Country Perspective.", World neurosurgery, vol. 152, pp. e220-e226, 2021. Abstract

OBJECTIVE: Multimodal intraoperative neuromonitoring (IOM) using somatosensory-evoked potentials and motor-evoked potentials is a sensitive and specific tool for detecting intraoperative neurologic injury during spine surgery. This study aimed to evaluate the use of multimodal IOM in a lower-middle-income country (LMIC) during cervical and thoracic spine surgery in order to prevent and predict new postoperative neurologic deficits early on. This is the first report of multimodal IOM application in LMICs.

METHODS: The neurophysiologist raised the cutoff warning criteria of 50 patients who underwent surgery for different cervical and thoracic pathologies to decrease postoperative neurologic deficits. We retrospectively reviewed the medical charts and neuromonitoring traces of these patients followed by calculating the sensitivity, specificity, positive predictive value, and negative predictive value of combined IOM for postoperative neurologic deficit occurrence.

RESULTS: A significant relationship was found between the reversibility of alerts and the development of new postoperative deficits (P < 0.001). There was no relationship between the cause of alerts and the reversibility of those alerts after corrective measures were carried out (P = 0.455), or the frequency of alerts and the development of new deficits postoperatively (P = 0.578). Sensitivity, specificity, positive predictive value, and negative predictive value of combined somatosensory-evoked potential and motor-evoked potential monitoring were 100%, 80%, 62.5%, and 100%, respectively.

CONCLUSION: Because of the limited experience and the many technical difficulties faced in LMICs, we found that this cutoff limit resulted in more false-positive warnings but helped to avoid any false-negative results, thus enhancing the safety of surgery.

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Baig, A. A., A. O. Aguirre, M. A. R. Soliman, C. C. Kuo, J. Lim, A. Khan, I. Chen, K. V. Snyder, E. I. Levy, A. H. Siddiqui, et al., "Standalone versus Anterior Cervical Plating for One-To-Two Level Anterior Cervical Discectomy and Fusion: A Propensity Score-Matched Comparative Study.", World neurosurgery, 2023. Abstract

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) can be performed with and without supportive anterior cervical plating. Fusion rates, incidence of dysphagia, and repeat surgery are concerns when performing ACDF with or without plating. We aimed to compare procedural success and outcomes between patients treated with and without cervical plating for 1-2 level ACDF.

METHODS: A prospectively maintained database was retrospectively searched for patients who underwent 1-2 level ACDF surgery. Patients were divided into cohorts treated with plating and without (standalone). Propensity score matching (PSM) was performed to eliminate selection bias and control for baseline comorbidities and disease severity. Patient demographics (including age, body mass index, smoking status, diabetes mellitus, osteoporosis), disease presentation (cervical stenosis, degenerative disc disease), and operative details (number of operative levels, cage type used, intraoperative, and postoperative complications) were recorded. Outcomes assessed were fusion observed at 3, 6, and 12 months, patient-reported postoperative pain, and any repeat surgeries. Univariate analysis was performed according to data normality and variables for PSM cohorts.

RESULTS: A total of 365 patients were identified (plating=289, standalone=76). After PSM, 130 patients (65 in each group) were included for final analysis. Similar mean operative times (101.3 ± 26.5-standalone; 104.8 ± 32.2-plating; P = 0.5) and mean hospital stays (1.2 ± 1.8-standalone; 0.7 ± 0.7-plating; P = 0.1) were noted. Twelve-month fusion rates were also similar (84.6%-standalone; 89.2%-plating; P = 0.6). Repeat surgery rates were equivalent (13.8%-standalone; 12.3%-plating; P = 0.8).

CONCLUSIONS: In this propensity score-matched case-control study, we report comparable effectiveness and outcomes of performing 1-2 level ACDF with and without cervical plating.

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Diaz-Aguilar, L., L. E. Stone, M. A. R. Soliman, A. Padovano, J. Ehresman, N. J. Brown, G. Produturi, M. Battista, A. Khan, J. Pollina, et al., "Radiographic alignment outcomes after the single-position prone transpsoas approach: a multi-institutional retrospective review of 363 cases.", Neurosurgical focus, vol. 54, issue 1, pp. E3, 2023. Abstract

OBJECTIVE: The aim of this paper was to evaluate the changes in radiographic spinopelvic parameters in a large cohort of patients undergoing the prone transpsoas approach to the lumbar spine.

METHODS: A multicenter retrospective observational cohort study was performed for all patients who underwent lateral lumber interbody fusion via the single-position prone transpsoas (PTP) approach. Spinopelvic parameters from preoperative and first upright postoperative radiographs were collected, including lumbar lordosis (LL), pelvic incidence (PI), and pelvic tilt (PT). Functional indices (visual analog scale score), and patient-reported outcomes (Oswestry Disability Index) were also recorded from pre- and postoperative appointments.

RESULTS: Of the 363 patients who successfully underwent the procedure, LL after fusion was 50.0° compared with 45.6° preoperatively (p < 0.001). The pelvic incidence-lumbar lordosis mismatch (PI-LL) was 10.5° preoperatively versus 2.9° postoperatively (p < 0.001). PT did not significantly change (0.2° ± 10.7°, p > 0.05).

CONCLUSIONS: The PTP approach allows significant gain in lordotic augmentation, which was associated with good functional results at follow-up.

Donnelly, B. M., D. E. Smolar, A. A. Baig, M. A. R. Soliman, A. Monteiro, K. J. Gibbons, E. I. Levy, and K. V. Snyder, "Analysis of craniectomy bone flaps stored in a neurosurgical cryopreservation freezer: microorganism culture results and reimplantation rates.", Acta neurochirurgica, vol. 165, issue 11, pp. 3187-3195, 2023. Abstract

BACKGROUND: Cryopreservation of bone flaps after decompressive craniectomies is a common practice. A frequent complication after bone flap reimplantation is postoperative infection, so culturing of frozen craniectomy bone flaps is a crucial practice that can prevent patient morbidity and mortality. Although many studies report on infection rates after cranioplasty, no study reports on the results of bone flaps stored in a cryopreservation freezer, reimplanted or otherwise. We sought to analyze the flaps in our medical center's bone bank freezer, including microorganism culture results and reimplantation rates of cryopreserved bone flaps.

METHODS: Patients who underwent craniectomy and had bone flaps cryopreserved between January 1, 2016, and July 1, 2022, were included in this retrospective study. Information about bone flap cultures and reimplantation or discard was obtained from a prospectively maintained cryopreservation database. Information including infection rates and mortality was acquired from a retrospective review of patient records. Culture results were obtained for all flaps immediately before cryopreservation and again at the time of reimplantation at the operator's discretion.

RESULTS: There were 148 bone flaps obtained from 145 patients (3 craniectomies were bilateral) stored in our center's freezer. Positive culture results were seen in 79 (53.4%) flaps. The most common microorganism genus was Propionibacterium with 47 positive flaps, 46 (97.9%) of which were P. acnes. Staphylococcus was the second most common with 23 positive flaps, of which 8 (34.8%) tested positive for S. epidermidis. Of the 148 flaps, 25 (16.9%) were reimplanted, 116 (78.4%) were discarded, and 7 (4.7%) are still being stored in the freezer. Postcranioplasty infections were seen in 3 (12%) patients who had flap reimplantation.

CONCLUSIONS: Considering the substantial number of positive cultures and limited reimplantation rate, we have reservations about the logistical efficiency of cryopreservation for flap storage. Future multicenter studies analyzing reimplantation predictors could help to reduce unnecessary freezing and culturing.

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El-Ghandour, N. M. F., A. A. M. Ezzat, M. A. Zaazoue, P. Gonzalez-Lopez, B. S. Jhawar, and M. A. R. Soliman, Virtual learning during the COVID-19 pandemic: a turning point in neurosurgical education, , vol. 49, issue 6: American Association of Neurological Surgeons, pp. E18, 2020. AbstractWebsite
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El-Ghandour, N. M. F., A. O. Aguirre, A. Goel, H. Kandeel, T. M. Ali, B. Chaurasia, S. Elmorsy, M. S. Abdelaziz, and M. A. R. Soliman, "Neurosurgical Wrong Surgical Site in Lower-Middle- or Low-Income Countries (LMICs): A Survey Study.", World neurosurgery, vol. 152, pp. e235-e240, 2021. Abstract

BACKGROUND: One of the most preventable errors of a surgeon's career is operating on the incorrect surgical site (ICSS). No study in any specialty has ever investigated the incidence of ICSS events in lower-income countries. This study focuses on identifying the occurrence of these events along with an analysis of potential causes leading to these unfortunate events.

METHODS: The authors distributed a survey to neurosurgical colleagues from around the world. These surgeons were first asked to identify details about their practice and incidence and personal experience with ICSS in their own careers. At the end of the survey, they responded to questions about their knowledge of safety checklists.

RESULTS: In this study there was a 63.4% response rate. When combined with those who participated through various social media platforms, there were 178 responses. The incidence rate for every 10,000 cases performed was found to be 22.8 in the cranial group, 88.6 in the cervical group, and 158.8 in the lumbar procedural group. This study identified that 40% of participants had never learned or experienced the ABCD time-out strategy and that 60% of surgeons did not use intraoperative navigation or imaging in their practices. The error has never been disclosed to the patient in 48% of the ICSS cases.

CONCLUSIONS: Due to a lack of application of safety checklist protocol, there is an increased occurrence of ICSS events in lower-income countries. The results of this study demonstrate the necessity of investing time and resources dedicated to avoiding preventable errors.

El-Ghandour, N. M. F., I. Lotfy, B. M. Ayoub, and M. A. R. Soliman, "Obituary for Professor Mohamed Lotfy Shehata", World Neurosurgery , vol. 156, pp. 147-148, 2021.
El-Ghandour, N. M. F., M. A. R. Soliman, A. A. M. Ezzat, A. Mohsen, and M. Zein-Elabedin, The safety and efficacy of anterior versus posterior decompression surgery in degenerative cervical myelopathy: a prospective randomized trial, , vol. 33, issue 3: American Association of Neurological Surgeons, pp. 288 - 296, 2020. AbstractWebsite
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El-Ghandour, N. M. F., E. H. Elsebaie, A. A. Salem, A. F. Alkhamees, M. A. Zaazoue, M. A. Fouda, R. G. Elbadry, M. Aly, H. Bakr, M. A. Labib, et al., "Letter: The Impact of the Coronavirus (COVID-19) Pandemic on Neurosurgeons Worldwide", Neurosurgery, vol. 87, issue 2: Oxford University Press, pp. E250 - E257, 2020/08/01. AbstractWebsite
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El-Ghandour, N. M. F., mohamed sawan, A. A. Abdelkhalek, T. Ali, and M. A. R. Soliman, "A Prospective Randomized Study of the Safety and Efficacy of Transforaminal Lumbar Interbody Fusion Versus Posterior Lumbar Interbody Fusion in the Treatment of Lumbar Spondylolisthesis: A Cost utility from a Lower-middle-income Country Perspective and Re", Open Access Macedonian Journal of Medical Sciences, vol. 9, issue B, pp. 636-645, 2021.
Elkady, A., M. A. R. Soliman, and A. M. Ali, Clinical Outcomes of Infratentorial Meningioma Surgery in a Developing Country, , vol. 137, pp. e373 - e382, 2020. AbstractWebsite

BackgroundNo data are available on incidence, surgical approaches, complications, and survival for patients with infratentorial meningiomas in developing countries. Predictors for surgical resection, recurrence, and complications were analyzed based on the surgical outcomes of patients with infratentorial meningiomas.
Methods
A total of 101 consecutive cases of infratentorial meningiomas operated on between April 2012 and April 2017 at our institute were reviewed retrospectively. The patients had a mean age of 55.1 ± 5 years, a female predominance of 62.3%, and the mean duration of follow-up duration was 44.2 ± 15.5 months.
Results
The most common surgical approach was retrosigmoid (n = 51) followed by suboccipital (n = 36), subtemporal (n = 8), and far lateral (n = 6). The preoperative presentation showed that affected cranial nerve was the most common presenting symptom (47.5%) followed by weakness (24.8%) and affected vision (16.8%) followed by headache (8.9%) and gait disturbance (6.9%). The extent of resection was grade I (n = 63), grade II (n = 15)and grade III (n = 23) according to the Simpson grading. The complication rate was 56 cases (55.4%); the most common complication was cranial nerve palsy (42.6%), followed by weakness (31.7%), hydrocephalus (16.8%), chest infection (8.9%), ataxia (4%), deep venous thrombosis (4%), cerebrospinal fluid leak (3%) and meningitis and pulmonary embolism (both 1%).
Conclusions
The location, surgical approach, preoperative Karnofsky Performance Status, and peritumor edema were significantly associated with complications. Compared with developed countries, we had a higher complication rate (P < 0.001), lower recurrence rate (P = 0.15), and slightly lower total resection rate (P = 0.29). These findings might be attributed to the patient's late presentation to the tertiary center and poor technical resources.

Elmallawany, M., H. Kandel, M. A. R. Soliman, T. A. Tareef, A. Atallah, A. Elsaid, and W. Elmahdy, "The Safety and Efficacy of Cervical Laminectomy and Fusion versus Cervical Laminoplasty Surgery in Degenerative Cervical Myelopathy: A Prospective Randomized Trial", Open Access Macedonian Journal of Medical Sciences, vol. 8, issue B, pp. 807-814, 2020/11/08. AbstractWebsite

<p><strong>BACKGROUND: </strong>There is a lack of evidence of whether degenerative cervical myelopathy (DCM) is best treated through cervical laminoplasty (CLP) or cervical laminectomy with lateral mass fusion due to the lack of prospective randomized studies that are well designed. We conducted the largest prospective randomized trial to date to determine the comparative effectiveness and safety of both approaches.</p><p><strong>METHODS: </strong>In this prospective, randomized trial, we randomly assigned patients who had symptoms or signs of DCM to undergo either cervical laminectomy and lateral mass fixation (CLF) or CLP. The primary outcome measures were the change in the Visual Analog Scale (VAS), neck disability index, modified Japanese Orthopedic Association (mJOA) score, and Nurick’s myelopathy grading 1 year after surgery. The secondary outcome measures were the intraoperative, post-operative complications, hospital stay, C2-7 Cobb’s angle, and Odom’s criteria. The follow-up period was at least 1 year.</p><p><strong>RESULTS: </strong>A total of 30 patients (mean age, 54.5 ± 5.5 years, 70% of men) underwent prospective randomization. There was a significantly greater improvement in neck pain (VAS) in the CLF group at 1 year (p &lt; 0.05). The improvement in the mJOA and Nurick’s myelopathy grading showed insignificant improvement between both groups. Furthermore, there was no significant difference in the patient’s post-operative satisfaction (Odom’s criteria). The mean operative time was significantly longer in the CLF group (p &lt; 0.001), with no significant difference in the post-operative complications, however, there was a higher rate of C5 palsy, dural tear and infection in the CLF, and a higher rate of instrumentation failure in the CLP. The mean hospital stay was significantly longer in the posterior group (p &lt; 0.05). Finally, there was a significant better improvement in the C2-7 Cobb’s angle at 1 year in the CLF group (p &lt; 0.05).</p><p><strong>CONCLUSION: </strong>Among patients with multilevel DCM, the CLF approach was significantly better regarding the post-operative pain and Cobb’s angle while the CLP was significantly better in terms of shorter hospital stay and operative time.</p>

Elwy, R., M. Soliman, A. Hasanain, ahmed ezzat, M. Elbaroody, M. Alsawy, and E. E. L. Refaee, Visual changes after space flight: is it really caused by increased intracranial tension? A systematic review, , vol. 64, 2020/04/29. Abstract
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Ezzat, A. A. M., M. A. R. Soliman, M. Baraka, M. E. Shimy, A. Ezz, and E. E. L. Refaee, "Distant large acute epidural hematoma after closed cerebrospinal fluid tapping through the anterior fontanelle: A case report and its pathogenesis.", Surgical neurology international, vol. 12, pp. 59, 2021. Abstract

BACKGROUND: Cerebrospinal fluid (CSF) infection is one of the most common and serious complications of shunt placement. The CSF shunt infections are preferably treated with intravenous antibiotics, infected shunt removal, repeated tapping (infants) or placement of an external ventricular drainage (EVD) device, and placement of a new shunt once the CSF is sterile. The tapping through the anterior fontanelle is commonly used instead of the EVD in developing countries to manage CSF infection in open anterior fontanelle patients. To the best of our knowledge, this would be considered the first reported case of distant epidural hematoma after closed ventricular tapping.

CASE DESCRIPTION: We report a case of 6-months child with Chiari malformation (Type II) presenting to us with a shunt infection with possible obstruction. CSF was aspirated for examination through a tap through the anterior fontanelle followed by the development of extradural hemorrhage far from the tapping site.

CONCLUSION: EDH after a transfontanellar ventricular tap can rapidly evolve and lead to patient death. This report raises the awareness of the neurosurgeons to this possible complication that can happen and leads to major complications. Monitoring the conscious level would be needed after ventricular tapping to detect this possible complication.

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G, W., S. MAR, A. A, and undefined, "Spontaneous spondylodiscitis: review, incidence, management, and clinical outcome in 44 patients", JNS: Neurosurgical Focus, issue January 2019, 2019.
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Haberfellner, E., M. Elbaroody, A. F. Alkhamees, A. Alaosta, S. Eaton, E. Quint, S. Shahab, A. O'Connor, J. Im, A. Khan, et al., "Primary Spinal Melanoma: Case Report and Systematic Review.", Clinical neurology and neurosurgery, vol. 205, pp. 106649, 2021. Abstract

INTRODUCTION: Primary malignant melanoma of the spinal cord (PSM) is a rare condition with limited evidence regarding its diagnosis (clinical and radiographic), management, and prognosis. Our aim was to report an extremely rare two cases of primary malignant melanoma of the spine one of them is sacral melanoma which represents the second reported case in the literature and to conduct a systematic review of the relevant literature.

METHODS: The diagnosis and management of these cases were retrospectively reviewed. Using the PRISMA guideline, we conducted a systematic review of the literature to analyze different management strategies and the prognosis of such pathology.

RESULTS: All two patients were operated on, and received gross total removal of their tumors, with extended follow up for tumor recurrences. One of the cases involved a sacral tumor, which was resected without adjuvant therapy. The other one was seen by oncology and received post-operative chemo- and radio- therapy. In addition to the aforementioned cases, we present a comprehensive review of the literature on PSM from 1950 to the present, demonstrating that PSM is a very rare tumor, with a limited counted number of cases reported worldwide.

CONCLUSION: In conclusion, we report an exceedingly rare two cases of primary malignant melanoma of the spine. Early surgical intervention is key to the management of these rare and aggressive tumors. GTR should be attempted if possible.