Vertebral body reconstruction by titanium mesh or PEEK after anterior cervical vertebroplasty, applications and difficulties

Cervical vertebroplasty is a successful operation for decompression of the spinal cord and optimum restoration of cervical lordosis in individuals with severe canal stenosis. In this research, we demonstrate our method of reconstruction and replacement to the cervical vertebral body disorders with an expandable titanium cage or polyetheretherketone (PEEK). Neurologic status, morbidity, and mortality were evaluated before and after the surgery. We conducted a single-center, prospective study for all patients with cervical vertebral body lesions, who underwent single-stage vertebrectomy with an expandable titanium cage or PEEK, plate and screws reconstruction of the vertebral body. The study period between January 2014 and June 2020 in Al- Azhar university hospitals. The study included 25 patients who underwent single-stage, anterior-approach surgery. We used an expandable titanium mesh cage in five of them, and the other 20 were reconstructed using PEEK, plate, and screws. All patients had neurological symptoms before surgery, including brachialgia, motor deficit, or sphincter problems. The mean follow-up was 45.7 months (1-65 months). Neurological improvement was recorded in 20 patients at the last follow-up time, and five patients were not improved.&nbsp

Endoscope-assisted transcranial surgery for anterior skull base meningiomas

Anterior skull base meningiomas are benign, dural-based tumors that originate from the tuberculum sellae, planum sphenoidale or olfactory groove. A multitude of traditional transcranial approaches have been effectively used for resection of these tumors. However, in the era of minimally invasive neurosurgery, the endoscopic endonasal and the endoscope-assisted or endoscope-controlled supraorbital keyhole eyebrow approaches stand out as the two main options utilized to resect these tumors. The supraorbital keyhole approach minimizes brain retraction, tissue dissection and length of the skin incision. Consequently, this approach is associated with a lower complication profile and much better cosmetic results in comparison to classic approaches. With endoscopic assistance or control, the approach provides an excellent view of anterior skull base meningiomas and enables optic nerve decompression when angled scopes are used. In our opinion, endoscopes will ultimately replace the surgical microscopes as the viewing tools in this type of surgery. A limited number of studies have directly compared the endoscopic endonasal approach versus the supraorbital keyhole one for resection of anterior cranial base meningiomas. In these studies, scores and algorithms have been suggested to help select the suitable approach. The practical value of these algorithms still needs to be validated by further research. Although the endoscope-assisted or -controlled supraorbital keyhole approach offers a minimally invasive and highly effective approach for excision of anterior cranial base meningiomas, the ideal approach should be tailored to the individual patient according to the tumor size, lateral extension, optic canal involvement, extent of vascular encasement and surgeon’s experience

Vertebral Body Reconstruction by Titanium Mesh or PEEK After Anterior Cervical Vertebroplasty, Applications and Difficulties

Cervical vertebroplasty is a successful operation for decompression of the spinal cord and optimum restoration of cervical lordosis in individuals with severe canal stenosis. In this research, we demonstrate our method of reconstruction and replacement to the cervical vertebral body disorders with an expandable titanium cage or polyetheretherketone (PEEK). Neurologic status, morbidity, and mortality were evaluated before and after the surgery. We conducted a single-center, prospective study for all patients with cervical vertebral body lesions, who underwent single-stage vertebrectomy with an expandable titanium cage or PEEK, plate and screws reconstruction of the vertebral body. The study period between January 2014 and June 2020 in Al- Azhar university hospitals. The study included 25 patients who underwent single-stage, anterior-approach surgery. We used an expandable titanium mesh cage in five of them, and the other 20 were reconstructed using PEEK, plate, and screws. All patients had neurological symptoms before surgery, including brachialgia, motor deficit, or sphincter problems. The mean follow-up was 45.7 months (1-65 months). Neurological improvement was recorded in 20 patients at the last follow-up time, and five patients were not improved.&nbsp