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2022
Refaee, E. E. L., M. Elbaroody, M. elShazly, H. Lasheen, A. Yousef, A. K. Abdelaziz, B. I. Alhayen, and K. H. A. L. E. D. B. A. S. S. I. M. ALI, "Endoscopic Endonasal Transsphenoidal Approach for a Giant Pituitary Adenoma in Pediatric Age Group: Operative Video.", Neurology India, vol. 70, issue 4, pp. 1370-1372, 2022.
"Elbaroody, M. ", A. " "El fiki, K. " "Eldabaa, M. " " Ghaneim, and M. " "Gabr, "Multiple clips reconstruction for giant fusiform Middle Cerebral Artery aneurysm", Interdisciplinary Neurosurgery, vol. 29, 2022.
2021
Refaee, E. E. L., and M. Elbaroody, "Endoscopic Fenestration of Arachnoid Cysts Through Lateral Pontomesencephalic Membranotomy: Technical Note and Case Series.", World neurosurgery, vol. 148, pp. 54-64, 2021. Abstract

BACKGROUND: The ideal treatment method for cranial arachnoid cysts stills controversial, each of endoscopic and microscopic techniques has its pros and cons.

METHODS: We described cystocisternostomy technique for arachnoid cysts through fenestration medial to the edge of tentorium through lateral pontomesencephalic membrane and illustrated it's outcomes. We performed endoscopic lateral pontomesencephalic membranotomy in nine children with zero angled rigid endoscope (STORZ).The age ranged from eight months up to nine years. The cysts were Galassi type III in eight cases (five of them giant hemispheric) and Galassi type II in one case. Clinical presentations were delay in milestones, seizures, loss of consciousness, unsteady gait, and persistent headache.

RESULTS: The cysts decreased in size in five cases after three months and nearly disappeared after three and 15 months in two cases, and in 18 months in the other two. Preoperative symptoms improved in all cases. Insignificant subdural hygroma was found in five cases, one case developed hydrocephalus four months later treated with a ventriculoperitoneal shunt; contralateral massive subdural hematoma occurred in one case four months after surgery evacuated with two burr holes with good clinical outcome. There was neither cerebrospinal fluid leakage, cranial nerve palsy nor mortality.

CONCLUSIONS: The fenestration through the lateral pontomesencephalic membrane created a shortcut of cerebrospinal fluid flow to the basal cisterns especially cerebellopontine cistern and represents a reliable option with an acceptable success rate. It creates a good drainage to the large cysts.

Elbaroody, M., M. A. Ghoneim, A. E. Fiki, H. Hozayen, and W. El-Mahdy, "Short-term outcomes of endoscopic evacuation of supratentorial spontaneous intracerebral hematoma: Early experience from developing country.", Surgical neurology international, vol. 12, pp. 309, 2021. Abstract

BACKGROUND: Minimally invasive endoscopic hematoma evacuation is a promising treatment option for intracerebral hemorrhage (ICH). However, the technique still needs improvement.

METHODS: We report our early clinical experience of using this technique to evacuate supratentorial spontaneous intracerebral hematomas and evaluate its short-term outcomes.

RESULTS: The study included 15 patients, basal ganglia hematoma was the most common location 62.5%, mean preoperative hematoma volume was 61.07 cc, mean ICH score was 3, and mean rate of hematoma evacuation was 89.27%. Factors that could be related to mortality were Glasgow Coma Score (GCS) on admission ( = 0.001), ICH score ( = 0.004); postoperative GCS ( < 0.001), postoperative hematoma volume ( = 0.006); intraventricular extension ( = 0.001), and rate of evacuation ( = 0.001).

CONCLUSION: Endoscopic technique is a safe surgical option for evacuation of spontaneous supratentorial ICH. This minimally invasive technique could be helpful to provide better short-term outcomes for selected patients. However, in our experience, this minimally invasive technique did not change the outcome for cases presented with poor GCS on admission 4/15. Our results warrant a future prospective, randomized, controlled efficacy trial.

2020
Soliman, M. A. R., M. Elbaroody, A. K. ElSamman, M. I. Refaat, E. Abd-Haleem, W. Elhalaby, H. Gouda, amr safwat, M. elShazly, H. Lasheen, et al., "Endoscopic endonasal skull base surgery during the COVID-19 pandemic: A developing country perspective.", Surgical neurology international, vol. 11, pp. 310, 2020. Abstract

BACKGROUND: Although primarily a respiratory disorder, the coronavirus pandemic has paralyzed almost all aspects of health-care delivery. Emergency procedures are likely continuing in most countries, however, some of them raises certain concerns to the surgeons such as the endoscopic endonasal skull base surgeries. The aim of this study is to present the current situation from a developing country perspective in dealing with such cases at the time of the COVID-19 pandemic.

METHODS: A cross-sectional analytical survey was distributed among neurosurgeons who performed emergency surgeries during the COVID-19 pandemic in Cairo, Egypt, between May 8, 2020, and June 7, 2020. The survey entailed patients' information (demographics, preoperative screening, and postoperative COVID-19 symptoms), surgical team information (demographics and postoperative COVID-19 symptoms), and operative information (personal protective equipment [PPE] utilization and basal craniectomy).

RESULTS: Our survey was completed on June 7, 2020 (16 completed, 100% response rate). The patients were screened for COVID-19 preoperatively through complete blood cell (CBC) (100%), computed tomography (CT) chest (68.8%), chest examination (50%), C-reactive protein (CRP) (50%), and serological testing (6.3%). Only 18.8% of the surgical team utilized N95 mask and goggles, 12.5% utilized face shield, and none used PAPRs. Regarding the basal craniectomy, 81.3% used Kerrison Rongeur and chisel, 25% used a high-speed drill, and 6.3% used a mucosal shaver. None of the patients developed any COVID-19 symptoms during the first 3 weeks postsurgery and one of the surgeons developed high fever with negative nasopharyngeal swabs.

CONCLUSION: In developing countries with limited resources, preoperative screening using chest examination, CBC, and CT chest might be sufficient to replace Reverse transcription polymerase chain reaction. Developing countries require adequate support with screening tests, PPE, and critical care equipment such as ventilators.

Elwy, R., M. A. Soliman, A. A. Hasanain, A. A. Ezzat, M. Elbaroody, M. F. Alsawy, and E. E. L. Refaee, "Visual changes after space flight: is it really caused by increased intracranial tension? A systematic review.", Journal of neurosurgical sciences, vol. 64, issue 5, pp. 468-479, 2020. Abstract

INTRODUCTION: Spaceflight-Associated Neuro-ocular Syndrome (SANS) was linked to increased intracranial pressure (ICP) attributable to the combined effects of microgravity and environmental conditions encountered during spaceflight. Microgravity countermeasures as lower body negative pressure (LBNP) are potential interventions for SANS. Our aim is to provide a comprehensive qualitative analysis of literature contrasting simulation and spaceflight studies, focusing on the pathophysiology of SANS, and highlighting gaps in current knowledge.

EVIDENCE ACQUISITION: We systematically searched PubMed electronic database for English primary research published until February 2019 discussing intracranial changes in spaceflight or simulated microgravity, excluding animal and experimental studies. Two authors screened all the abstracts with a third author resolving disagreements. The full-text manuscripts were analyzed in pilot-tested tables.

EVIDENCE SYNTHESIS: Nineteen studies were reviewed; 13 simulation, and two out of six spaceflight studies were prospective. ICP changes were investigated in 11 simulation studies, where eight demonstrated a significant increase in ICP after variable periods of head-down tilt. three showed a significant increase in intraocular pressure (IOP) in conjunction with ICP elevation. With increasing ambient CO2: one showed an increase in IOP without further increase in ICP, while another showed a slight further decrease in ICP. LBNP demonstrated no significant effect on ICP in one and a decrease thereof in another study. After spaceflight, increased ICP on lumbar puncture was demonstrated in five studies.

CONCLUSIONS: Exposure to microgravity increases ICP possibly precipitating ocular changes. Whether other factors come into play is the subject of investigation. Further randomized studies and methods of direct ICP measurement during spaceflight are needed.

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