Medicine and Health Sciences Commons^™

Endoscopic Lumbar Stenosis Decompression Through Uniportal Bilateral Approach, Yosouf Barakat, Magdy Asaad El-Hawary, Usama Mohamed El Shokhaiby, Ahmed Kamal Abdel-Aaty Abdou

Al-Azhar International Medical Journal

Background: Percutaneous endoscopic stenosis lumbar decompression (PESLD) is regarded as a noteworthy therapeutic option for lumber spinal stenosis (LSS), particularly on the contralateral side, in a satisfactory manner. Objective: To evaluate the efficacy and efficiency of PESLD of LSS through a uniportal-contralateral approach. Subjective: This was a prospective observational study. The patients were admitted to the Neurosurgery Department, Damanhour Educational Hospital, El-Behira Governorate, and Al Hussain Hospital Al Azhar University in Cairo. All patients underwent PESLD through a uniportal-contralateral approach.. Results: The pre-operative visual analogue scale (VAS) was 7.3 ± 0.9 and decreased significantly post-operative to 2.4±1.0. Intraoperative data showed …

Stereotactic Ablative Surgery For Movement Disordres, Ahmed Jamal Awad Al Demiry, El Sayed Abdel Rahman El Mor, Alaa Rashad Ibrahim

Al-Azhar International Medical Journal

Background: Since its inception in the early 1950s, the radiofrequency (RF) ablative technique has served a crucial function in the treatment of movement problems. Ablative surgery is encouraging since it doesn't require substantial perioperative care, doesn't run the risk of hardware issues, and it expenses less than deep brain stimulation. Aim of the work: This study is to evaluate the efficacy and safety of RF ablative surgery for medically intractable movement disorders. Patients and Methods: This study was conducted retrospectively on 20 patients with medically refractory movement disorders who had undergone macrostimulation-guided RF ablative surgery in the institutions affiliated with …

An Endoscopic Journey To The Center Of The Skull Base For Novice Neurosurgeons: From Cadaver To Theater, Alhusain Nagm, Mohammed Hamadah, Kamal Elbaz, Ibrahim Ewiss

Al-Azhar International Medical Journal

Background: For novice neurosurgeons (nNS), it is important to determine the safety of extended-endoscopic endonasal approaches (eEEA) by analyzing/eliminating surgical drawbacks. Aim: To evaluate the impact of cadaveric training for nNS on reducing obstacles/complication rates in the operative theater.

Subjects and Methods: This unique study has two parts: first; the lab/cadaveric part included a checklist scoring system to estimate the ability of nNS to dissect/identify basic and complex anatomical landmarks (BCAL) (n=50) via eEEA for the center of the skull base (CSB) using 2 formalin-fixed heads and a dry skull for tumor simulation. Second; theater/clinical part included 28 cases with …

Role Of Conventional And Pulsed Radiofrequency In Treatment Of Low Back Pain And Sciatica, Maamoun Mohammed Abo Shosha, Mohammed Ahmed Ellabbad, Mostafa Soliman Elmaghraby, Ahmed Maher Ahmed Ibrahim

Al-Azhar International Medical Journal

Background: Low back pain is a feeling of discomfort, stiffness, or muscle tension below the costal border in the upper part of the back of the thigh, above the lower gluteal folds. Sciatica can occur with low back pain. The two most common techniques are pulsed radiofrequency (PRF) and conventional radiofrequency (CRF). Both techniques employ heat produced by particle vibration to cause a lesion. PRF employs intermittent high-frequency current injection to diffuse heat into nearby tissues and prevent temperatures from rising beyond 42 °C, known as the neuronal injury threshold.

Aim of the study: To assess the efficacy of PRF …

Outcome Of Epilepsy Surgery In Pediatrics, Mohammed Refaat Mohammed Hammouda, Shehab M. El Khadrawy, Mohamed Hasan Mansour, Alaa Rashad Ibrahim Hassan, Alazzazi Rabei

Al-Azhar International Medical Journal

Background: Epilepsy is a brain disorder characterized by recurrent attacks of seizures. A seizure is a sudden change of behavior due to a transient alteration in the electrical pattern of the brain. Since despite appropriate drug treatment, one-third of patients continue to have seizures, other treatment must be considered. Aim: This study aims at emphasizing the importance of epilepsy surgery in pediatrics by assessing surgical outcome as regard seizure freedom and surgical morbidity & mortality at Al-Azhar university hospitals.

Patients and Methods: Prospective and retrospective study on 27 pediatric patients diagnosed as drug resistant epilepsy, with 6 months to 1 …

Outcome Of Lumbar Discectomy By Using Endoscopic Interlaminar Approach, Ibrahim Gamil Ewaiss, Mostafa Mahmoud El Sayed Aboelkhir, Abelgelel Ragab Abdelgelel Atta

Al-Azhar International Medical Journal

Background: Lumbar degenerative disc disease is a condition which causes anatomical and morphological changes leading to clinical complaints. Lumbar disc herniation (LDH) is a common neurosurgical disease which causes economic and medical burdens to families, society and country. Aim: This study sought to assess the effectiveness of interlaminar endoscopic lumbar discectomy as a minimally invasive method for treating lumbar disc herniation in Al-Azhar university hospitals. Patients and Methods: This study, which included both prospective data, involved 25 patients between February 2021 to October 2022 who had lumber disc prolapse and were treated with endoscopic lumbar discectomy using the EasyGo system …

Anterior Cervical Discectomy And Fusion Using Cages Versus Cages And Plating, Hamdy Mohamed Behiry, Mansour Ali Hendawy, Mahmoud Mohammed Bayoumi

Al-Azhar International Medical Journal

Background: The anterior column receives rapid load bearing support, the disc space height is restored, foraminal decompression occurs, and interbody fusion is facilitated by cervical intervertebral disc replacement with cage. Aim: Aim of work was to assess the interbody fusion rate and to assess incidence of complications of 20 consecutive patients for degenerative one or more level anterior cervical disc utilizing cage/s versus cage/s and plate. Patients and Methods: A comparative research of 20 patients with degenerated cervical discs managed by an anterior cervical discectomy procedure and fusion (ACDF) using either cage alone (ACDF-CA) or cage and anterior plating (ACDF-CPC). …

Assessment The Efficacy Of Stent Assisted Techniques For Endovascular Management Of Complex Anterior Circulation Cerebral Aneurysm, Ahmed Mohamed Farid Alsayed, Ali Khodair Ali Khodair, Mohamed Abdalaziz Elbily

Al-Azhar International Medical Journal

Background: Stent-assisted coiling is an established treatment option for intracranial aneurysms, particularly, wide neck aneurysms with complex anatomy.

Aim of the work: To assess safety, efficacy, and outcome of stent-assisted endovascular management of complex anterior circulation cerebral aneurysm.

Patient and methods: In a prospective and retrospective study, 15 patients diagnosed clinically and radiologically to have unruptured complex anterior circulation cerebral aneurysm and underwent endovascular stent assisted techniques at the Neurosurgical Intervention Unit at AL Hussein University Hospital were recruited in the period from beginning of Feb 2022 to the end of Feb 2023. Efficacy was assessed immediately post-procedure using Raymond−Roy …

Cages Alone Versus Plate Fixation With Cages After Four Levels Anterior Cervical Discectomy, Karim Mohamed Mohamed Elshafei, Ibrahim Gamel Ewaiss, Taha Mohamed Adel Fawi, Hamdi Nabawi Mostafa

Al-Azhar International Medical Journal

Purpose: This study assessed clinical and radiological outcomes to support the surgical decision of ACDF using cages alone versus cage-with-plate fixation in patients with four-level spondylotic myelopathy of the cervical spine.

Methods: This study enrolled 30 patients with four levels of cervical spondylotic myelopathy. The C Group (n=15) was subjected to ACDF using four cages, and the C&P Group (n=15) had additional plate fixation. They were followed up clinically and radiologically for at least 12 months. Scheduled for surgical intervention in the neurosurgery department of Misr University and hospitals of Al Azhar University and Nasr Institute from October 2020 to …

Transforaminal Endoscopic Lumbar Discectomy, Elsayed Abdelrahman Elmor, Abdelbaset Ali Saleh, Abdelelah Nazeer Yasin, Abdelreheem Mahmoud Mohamed, Ezz Eldeen Elsayed Mohammed Ibrahim

Al-Azhar International Medical Journal

Background: Clinical problems might result from the structural and morphological changes brought on by lumbar degenerative disc degeneration. The medical costs and lost productivity that result from treating lumbar disc herniation (LDH) are a major burden on families, communities, and nations.Lumbar Discectomy for Prolapsed Intervertebral Disc associated with radicular symptoms in lower limb is probably the most widely performed spinal intervention. Aim: Percutaneous transforaminal endoscopic lumbar discectomy is a less invasive approach for treating LDH, and the purpose of this study is to assess its efficacy. Subject and method: This study was conducted at the neurosurgery department, Ibn Sina hospital …

Conservative Versus Surgical Management Of Cranial Pediatric Epidural Hemorrhage, Shehab M. Elkhadrawy, Mohamed Hasan Mansour, Wael F. Sanad

Al-Azhar International Medical Journal

No Abstract

Skull Base Reconstruction After Endoscopic Endonasal Skull Base Surgery, Mostafa El-Sayed Mohammed, Hany Hafez Sherif, Islam Mohammed Alaghory, Ahmed Nossir Abd El-Khalek Mobarak

Al-Azhar International Medical Journal

Background: CSF leakage following surgery is a known potential complication associated with substantial morbidity & mortality. Numerous techniques for prevention & treatment after endoscopic skull-base surgery are described. These include lumbar drain, autologous grafts like fat, muscle and fascia and synthetic materials like a polyester-silicon dural substitute. But these grafts alone were associated with a high failure rate, particularly in large defects. The application of vascularized flaps promotes more rapid and complete healing and was associated with a sharp decrease in CSF leaks. These vascularized flaps include nasoseptal, inferior turbinate and peri-cranial flaps. The most common nasoseptal flap (NSF) is …

Assessment Of Lateral Orbitotomy Approach In Management Of Extraconal Orbital Lesions, Samy Ibrahim, Mohammed Hassan, Shymaa Adel Ismael

Al-Azhar International Medical Journal

Background: A variety of tumors and pseudotumors can occur in the orbital region, requiring distinct surgical approaches based on lesion characteristics.

Aim of the work: To evaluate the effectiveness of the lateral orbitotomy approach in the surgical management of extraconal orbital lesions.

Patients and Methods: A retrospective review of 14 patients who underwent lateral orbitotomy for extraconal orbital lesions at Al Azhar University Hospitals and Al Salam Specialized Hospital between July 2019 and July 2022. The main outcomes measured included postoperative complications and symptom resolution.

Results: A total of 14 patients were included (7 males, 7 females), with a mean …

Clinical Outcome Of Corpus Callosotmy For Management Of Drug Resistant Epilepsy, Islam Magdy Ali Ibrahim, Mamoun Abo Shosha, Mohamed Meligy Rabea Hamed

Al-Azhar International Medical Journal

Background: One of most common chronic neurologic disorders is epilepsy. incapability of significantly reduce percentage of studied cases resistant to all available antiepileptic treatments without producing unacceptable side effects is particularly frustrating. Aim & objectives: Aim of research was to investigate seizure result following corpus callosotomy in relation to extent of resection in pediatric studied cases with Symptomatic generalized epilepsy with normal preoperative brain imaging on MRI Brain. Studied cases & Methods: Research entails prospective analysis of data from 20 pediatric patients who were treated for intractable symptomatic generalized epilepsy by corpus callosotomy. Results: In our patient series, 13 patient …

Endovascular Management For Carotid Artery Stenosis With Or Without Using Of Distal Protection Device, Mostafa Y. Ali, Mohammed Abdulaziz Albialy, Magdy A. El Hawary

Al-Azhar International Medical Journal

Background: Transient ischemic episodes and ischemic strokes are frequently brought on by internal carotid artery atherosclerotic stenosis. Carotid artery stenosis can be treated with medicine, surgery, endovascular therapy, stenting, or a combination of these methods.

Aim of the work: Analyzing the various endovascular treatment options for carotid artery stenosis with and without filters.

Patients and Methods: This is a prospective and retrospective study, was conducted on 30 patients with carotid artery stenosis; 13 with filter and 17 without filter undergoing different endovascular techniques.

Results: In this study we found that in group A, mean age of patients 65.85 (±7.29) while …

Reduced Risk Of Reoperations With Modern Deep Brain Stimulator Systems: Big Data Analysis From A United States Claims Database, Chengyuan Wu, Sean J Nagel, Rahul Agarwal, Monika Pötter-Nerger, Wolfgang Hamel, Ashwini Sharan, Allison T Connolly, Binith Cheeran, Paul S Larson

Department of Neurosurgery Faculty Papers

Objective: There have been significant improvements in the design and manufacturing of deep brain stimulation (DBS) systems, but no study has considered the impact of modern systems on complications. We sought to compare the relative occurrence of reoperations after de novo implantation of modern and traditional DBS systems in patients with Parkinson's disease (PD) or essential tremor (ET) in the United States.

Design: Retrospective, contemporaneous cohort study.

Setting: Multicenter data from the United States Centers for Medicare and Medicaid Services administrative claims database between 2016 and 2018.

Participants: This population-based sample consisted of 5,998 patients implanted with a DBS system, …

Role Of Intra-Operative Ultrasound In Brain Tumour Surgeries, Mohammad Hamza Bajwa, Saqib Kamran Bakhshi, Muhammad Shahzad Shamim

Section of Neurosurgery

The use of intra-operative ultrasound remains a largely underutilized option in brain tumour surgeries. The widespread availability of neuronavigation may be the reason why such a useful modality has become less popular even though recent advances in ultrasound technology have greatly improved its utility. The available literature also clearly shows that it offers additional advantages especially when used with neuronavigation. Herein the authors have briefly touched upon the available literature on the role of intraoperative ultrasound in brain tumour surgeries.

Tranexamic Acid To Reduce Head Injury Death In People With Traumatic Brain Injury: The Crash-3 International Rct, Ian Roberts, Haleema Shakur-Still, Amy Aeron-Thoma, Danielle Beaumont, Antonio Belli, Amy Brenner, Madeleine Cargill, Rizwana Chaudhri, Nicolas Douglas, Rashid Jooma

Section of Neurosurgery

Background: Tranexamic acid safely reduces mortality in traumatic extracranial bleeding. Intracranial bleeding is common after traumatic brain injury and can cause brain herniation and death. We assessed the effects of tranexamic acid in traumatic brain injury patients.
Objective: To assess the effects of tranexamic acid on death, disability and vascular occlusive events in traumatic brain injury patients. We also assessed cost-effectiveness.
Design: Randomised trial and economic evaluation. Patients were assigned by selecting a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients, caregivers and those assessing outcomes were masked to allocation. …

Surgical Education And Training, Ather Enam, Hammad Ather, Nadeem Ahmed Siddiqui

Section of Neurosurgery

No abstract provided.

A Primer On Cognitive Errors Illustrated Through The Lens Of A Neurosurgical Practice, Jeffrey Evan Florman, Lisa Almeder, Robert Trowbridge

Journal of Maine Medical Center

Problem Statement:

Diagnostic error is often attributed to cognitive errors, including biased thinking patterns, rather than knowledge or data limitations, and education on cognitive bias deserves review in all spheres of practice.

Background:

The cognitive biases of practitioners create an inherent fallibility in recognizing and treating medical conditions. Awareness of cognitive errors is valuable for mitigating risk of diagnostic error.

The impact of cognitive error is substantial in the management of neurosurgically relevant disease. Remarkably broad differential diagnoses often accompany neurologic symptoms. Both focal and non-focal symptoms lend themselves to diagnostic inertia that contributes to errors. Further, initial diagnostic direction …

A Feasibility Study Of Lavender Aromatherapy In An Awake Craniotomy Environment, Kailah Cathey, Nichole Gunyon, Nancy Chung, Nancy Conway, Diane Ames, Maharaj Singh, Amin B. Kassam, Richard A. Rovin

Journal of Patient-Centered Research and Reviews

Purpose: Integrative medicine interventions are needed for awake craniotomies, as many patients experience anxiety. Lavender aromatherapy significantly reduces anxiety or pain in a variety of surgical procedures. This feasibility study used lavender aromatherapy during awake craniotomies to determine the number of patients who would consent and complete the study, the technicality of lavender aromatherapy use, and acceptance by operating room (OR) staff.

Methods: We approached 40 consecutive patients (≥18 years old). Exclusion criteria were pulmonary issues or sensitivity to lavender. Outcome measures in consented patients were enrollment and completion rates, anxiety and pain as measured by the Visual Analog Scale …

Brief History Of Spinal Neurosurgical Societies In The United States: Part 1., Sasha Vaziri, Daniel K. Resnick, Christopher P. Ames, James S. Harrop, Christopher I. Shaffrey, Kern Singh, Justin S. Smith, Daniel J. Hoh

Department of Neurosurgery Faculty Papers

No abstract provided.

Management Of Traumatic Subarachnoid Hemorrhage By The Trauma Service: Is Repeat Ct Scanning And Routine Neurosurgical Consultation Necessary?, Stephen W. Cooper, Kimberly B. Bethea, Trevor J. Skrobut, Rod G. Gerardo, Juan Torres-Reveron, Akpofure Peter Ekeh

Department of Surgery Faculty Publications

Subarachnoid hemorrhage (SAH) results frequently from traumatic brain injury (TBI). The standard management for these patients includes brief admission by the acute care surgery (trauma) service with neurological checks, neurosurgical consultation and repeat head CT within 24 hours to identify any progression or resolution. Recent studies have questioned the need for repeat CT imaging and specialty consultation in mild TBI. We reviewed patients with mild TBI specifically with isolated SAH to determine progression of the pathology and need for neurosurgical involvement. All patients with SAH secondary to mild TBI (Glasgow Coma Score (GCS) of 13-15) who presented over a 5-year …

Commentary: The History Of Neurosurgery At Albany Medical College And Albany Medical Center Hospital, Albany, New York., Pouya Entezami, Michael R. Gooch, Adedamola Adepoju, Julie Pilitsis, Tyler J. Kenning, Alan Boulos, David L. Semenoff

Department of Neurosurgery Faculty Papers

The origins of the Department of Neurosurgery at Albany Medical College closely parallel the development of early America and the establishment of modern health care.The tales of Washington Irving, the works of the Hudson River School of painters, and summers in the Catskill Mountains or Adirondacks are the stories that color the history of Upstate New York (Figure1). As a social, industrial, and political hub of the American colonies, New England’s need for centers providing structured medicine led to the creation of Albany Medical College in1839, one of the earliest such institutions in the young nation.1 Rapid progress in nearly …

Endovascular Coiling Versus Neurosurgical Clipping For Aneurysmal Subarachnoid Hemorrhage: A Systematic Review And Meta-Analysis, Syed Ijlal Ahmed, Gohar Javed, Syeda Beenish Bareeqa, Syeda Sana Samar, Ali Shah, Arwa Giani, Zainab Azam, Abeer Tasleem, Syed Hasham Humayun

Section of Neurosurgery

Background: Aneurysmal subarachnoid hemorrhage is a frequently devastating condition with a reported incidence of between 10 and 15 people per 100,000 in the United States. Currently, according to the best of our knowledge, there are not enough meta-analyses available in the medical literature of the last five years which compare the risks and benefits of endovascular coiling with neurosurgical clipping.
Methods: Twenty-two studies were selected out of the short-listed studies. The studies were selected on the basis of relevance to the topic, sample size, sampling technique, and randomization. Data were analyzed on Revman software.
Results: Mortality was found to be …

Consensus Statement From The International Consensus Meeting On The Role Of Decompressive Craniectomy In The Management Of Traumatic Brain Injury: Consensus Statement, P. J. Hutchinson, A. G. Kolias, T. Tajsic, A. Adeleye, A. T. Aklilu, T. Apriawan, A. H. Bajamal, E. J. Barthelemy, J. S. Ullman, F. Servadei, +41 Additional Authors

Journal Articles

No abstract provided.

Improving Medical And Endovascular Management For Acute Ischemic Stroke Through Multidisciplinary Education And Simulation, Richard F. Schmidt, Md, Megan Margiotta, Md, Elan Miller, Md, Robin D'Ambrosio, Bsn, Scrn, Robin Dharia, Md, Maria Aini, Md, Diana Tzeng, Md, Fred Rincon, Md, Pascal Jabbour, Md, Nabeel Herial, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Primary goals:

1. Reduce door to treatment times (both DTN and DTP) to meet and exceed existing guidelines metrics.
2. Educate residents about acute stroke management, including national guidelines and new institutional protocols to improve efficiency during stroke alerts.

Rare Case Of Diffuse Spinal Arachnoiditis Following A Complicated Vertebral Artery Dissection, Elias Atallah, Md, Sophia Dang, Sage Rahm, Nohra Chalouhi, Md, Stavropoula Tjoumakaris Md, Robert H. Rosenwasswer Md, Pascal Jabbour Md

Department of Neurosurgery Posters

Spinal arachnoiditis (SA) is an extremely rare and delayed complication of intracranial subarachnoid hemorrhage (SAH). SA is an inflammatory process leading to chronic fibrosis of the spinal cord. Possible pathophysiology is a two-staged disease of initial inflammatory reaction secondary to SAH, followed by a “free interval phase” prior to delayed adhesive phase (i.e. SA). The clinical course can be complicated and is the cause of major morbidity.

Robotics In Neurosurgery: A Literature Review, Syed Ijlal Ahmed, Gohar Javed, Bakhtawar Mubeen, Syeda Beenish Bareeqa, Hiba Rasheed, Alizay Rehman, Masroor Mubeen Phulpoto, Syeda Sana Samar, Kashif Aziz

Section of Neurosurgery

Robotic surgery has been the forte of minimally invasive stereo-tactic procedures for some decades now. Ongoing advancements and evolutionary developments require substantial evidence to build the consensus about its efficacy in the field of neurosurgery. Main obstacle in obtaining successful results in neurosurgery is fine neural structures and other anatomical limitations. Currently, human rationalisation and robotic precision works in symbiosis to provide improved results. We reviewed the current data about recent interventions. Robots are capable of providing virtual data, superior spatial resolution and geometric accuracy, superior dexterity, faster manoeuvring and non-fatigability with steady motion. Robotic surgery also allows simulation of …

Delayed Spinal Cord Infarction Following Anterior Cervical Surgical Decompression, Muhammad Faheem Khan, Rashid Jooma, Fauzan Alam Hashmi, Muhammad Faraz Raghib

Section of Neurosurgery

Anterior cervical discectomy and fusion (ACDF) for cord compression is a safe and effective procedure with good outcomes. However, worsening of myelopathy is the most feared adverse event of the surgery. We report the case of a 36-year-old male patient who presented with an acute non-traumatic C5-6 cervical disc herniation causing incomplete quadriparesis. He underwent an uncomplicated ACDF at C5-6, and after an initial period of improvement, he developed a delayed onset of an anterior cord syndrome on day 3, without any discerning cause. We have reviewed similar cases reported in the literature and believe that our patient's postsurgical course …