Parasagittal Meningioma surgery

Background: meningioma in parasagittal location represent between 20%-30% of meningioma in the cranial cavity. The close relation of it with Superior Sagittal Sinus make its surgical resection is a great challenge to the surgeon to get a good result.Patients & method: we collected 23 cases of Parasagittal Meningioma cases medical records (including pre-& postoperative clinical pictures, images plus operative details and complications post operatively) who admitted to neurosurgery dept., Mansoura University Hospital and underwent surgical resection in the period that began in 2010 and ended in 2016. We followed up the cases at least for 6 months.Results: the patient’s age varied between 64-35 years. 16 female & 7 males. The presenting symptoms was headache (11 patients), fits (6 patients), motor weakness (5 cases), abnormal gait (1 patient) and dizziness (1 case). 15 cases had gross total tumor excision while 8 cases showed partial tumor removal. Recurrence rat was in 4 cases (17.4%) plus two mortality cases.Conclusion: through our series we could detect cardinal factors in prognosis of these cases which included: tumor size, histology, preoperative identification of the venous collateral and preservation of it in the surgical maneuver. The meticulous microscopic surgical technique can augment this goal

Outcome of medial sphenoidal wing meningioma surgery

Background: Sphenoid wing meningiomas among difficult surgery tumours due to involvement of important structures like optic nerve, cavernous sinus or carotid artery.Objective: to evaluate outcome and prognostic factors in patients with medial sphenoid wing meningiomas after microsurgery in a series of 47 patients with medial sphenoid wing meningioma.Method: This paper includes analysis of 47 patients & their data who underwent surgical management for meningiomas involving the medial sphenoid wing in the period between Jan 2008 and February 2016 at Mansoura university hospital.Results: The most of patients were suffering from visual impairment (59.6%), followed by headaches (38.2%). Total tumor resection were achieved in 23 cases, incomplete in 19 cases and partial resection in 5 cases. Visual acuity improved or stable in 57.4% of the patients. Preoperative neurological deficit remains unchanged postoperative in 35 cases while improved in 4 cases. 8 cases developed permanent 3rd Nerve palsy. Tumor recurrence was in 7 patients.Conclusion: There are many factors influence the prognosis of inner sphenoid wing meningioma including the extent of surgical resection, cavernous sinus invasion, present or absent of peritumoral edema, vascularity of the tumor, size of the tumor, presence or absence of arachnoid plane between the tumor and surrounding neurovascular structures and preoperative neurological condition

Efficacy of electromyography and nerve conduction velocity monitoring in surgical management of terminal lipoma in children

Background: the prognosis of Terminal lipomas is better than that of other sites and pathology especially their management nowadays became clearer with better surgical outcome due to advancement of surgical tools and neurophysiology study. Objective: to assess the outcome of excision of terminal lipomyelomeningocele and reconstruction of the neural tube. Methods: From 2002 to 2016, 32 cases of terminal lipomyelomeningocele in Mansoura university hospital, insurance hospital and El Ahrar specialized center, the age of the cases ranged between 10 days and 4,3 years underwent surgical management of total or near-total lipoma excision and neural tube reformation with minimum follow up of 6 months. Results: according to system which applied to show the success of the operations, Of the 32 patients, 9 cases represent (28.1%) showed total excision of the lipoma; 17 patients represent (53.1%) had 25 mm3 of lipoma or less and 6 patients represent (18.75%) had 26 mm3 of fat or more. The neurological and urological complications was about 25%, while other complications like cerebrospinal fluid leak, wound disruption and infection was 9.4%. The surgical morbidity was comparable with the published papers. Conclusion: the excision of terminal lipomyelomeningocele and recreation of the neural tube by monitoring throughout EMG & NCV with low surgical morbidity and better results than leaving them without management or surgical interference without neurophysiological monitoring.Key words: terminal lipomyelomeningocele, lipoma, Reconstruction of neural placode. Abbreviations: DREZ, dorsal root entry zone; MRI, magnetic resonance imaging, CSF, cerebrospinal fluid