Background. Surgical removal (gross total or partial removal), radiotherapy and cyst evacuation have all been used individually or in combination to treat cystic craniopharyngioma, although it is unclear which is the best method. Objective. To report the results of treating cystic craniopharyngioma by insertion of an Ommaya reservoir system (ORS) and aspiration of the cyst. Patients and methods. As from 1990, patients admitted to the neurosurgical department at Assiut University Hospital, Egypt, with grossly cystic craniopharyngioma and who had a single cyst and did not have previous surgery were treated by insertion of an ORS and drainage of the cyst. By 2010, 52 patients had received this treatment with the cystic fluid aspirated completely on the day of surgery. The main presenting symptoms were raised intracranial pressure and visual changes with hormonal changes observed in some patients. The minimal follow-up period was 7 years. Results. To our surprise, 38 (73%) patients did not develop any recollection of the cyst and showed significant clinical improvement. The only possible explanation is that the part of the catheter of the ORS, with holes in, has established communication between the cyst and the CSF spaces around it after the collapse of the cyst with no adverse effect on the patient at any time. Ten (19%) patients needed reaspiration every 6 months and four (8%) patients showed rapid recollection of cystic fluid and were treated with intracystic bleomycin. Conclusion. Treatment of cystic craniopharyngioma by drainage through an ORS is very effective. The majority of patients do not need any further treatment. Those who develop re-accumulation of cystic fluid are easily treated by simple aspiration of the fluid through the reservoir. It is a simple and safe method, which lacks the risks associated with surgery or chemotherapy.

Background. Surgical removal (gross total or partial removal), radiotherapy and cyst evacuation have all been used individually or in combination to treat cystic craniopharyngioma, although it is unclear which is the best method. Objective. To report the results of treating cystic craniopharyngioma by insertion of an Ommaya reservoir system (ORS) and aspiration of the cyst. Patients and methods. As from 1990, patients admitted to the neurosurgical department at Assiut University Hospital, Egypt, with grossly cystic craniopharyngioma and who had a single cyst and did not have previous surgery were treated by insertion of an ORS and drainage of the cyst. By 2010, 52 patients had received this treatment with the cystic fluid aspirated completely on the day of surgery. The main presenting symptoms were raised intracranial pressure and visual changes with hormonal changes observed in some patients. The minimal follow-up period was 7 years. Results. To our surprise, 38 (73%) patients did not develop any recollection of the cyst and showed significant clinical improvement. The only possible explanation is that the part of the catheter of the ORS, with holes in, has established communication between the cyst and the CSF spaces around it after the collapse of the cyst with no adverse effect on the patient at any time. Ten (19%) patients needed reaspiration every 6 months and four (8%) patients showed rapid recollection of cystic fluid and were treated with intracystic bleomycin. Conclusion. Treatment of cystic craniopharyngioma by drainage through an ORS is very effective. The majority of patients do not need any further treatment. Those who develop re-accumulation of cystic fluid are easily treated by simple aspiration of the fluid through the reservoir. It is a simple and safe method, which lacks the risks associated with surgery or chemotherapy.

Introduction: Chiari I malformation (CIM) is a congenital abnormality defined as downward herniation of the cerebellar tonsils through the foramen magnum. Syringomyelia is present in 30–85% of cases. Magnetic resonance (MR) imaging has increased the frequency of diagnosis of this complex disorder. Great variety exists in the indications and techniques recommended for the surgical management of this complex. Methods: In a group of 23 prospectively selected patients (15 males and 8 females) having (CIM) with and without syringomyelia (11 patients and 12 patients respectively) during a five years period from January, 2005 to January, 2010. Cranio-cervical bony decompression alone was done in 8 patients, Cranio-cervical bony decompression with duroplasty was done in 12 patients, and Cranio-cervical bony decompression with syringo-subarachnoid shunt was done in three patients. Outcome was defined as good, fair, or bad. Results: During a mean follow-up period of 32 months, the overall outcome was good in 19 patients (83%), fair in 3 patients (13%), and bad in one patient (4%). No operative mortality or permanent post operative morbidity was encountered. Transient post operative morbidity was encountered in 6 patients (26%) namely mild temporary neurological deterioration, CSF leak, and mild wound sepsis. There were no statistically significant differences between the various decompressive approaches. Conclusion: Decompression of the cranio-cervical junction through suboccipital craniectomy (SOC) with cervical laminectomy, duroplasty, or syringo-subarachnoid shunt is the recommended surgical management option for CIM±S. Further studies utilizing larger patient volumes are necessary to confirm our recommendation.

Introduction: Chiari I malformation (CIM) is a congenital abnormality defined as downward herniation of the cerebellar tonsils through the foramen magnum. Syringomyelia is present in 30–85% of cases. Magnetic resonance (MR) imaging has increased the frequency of diagnosis of this complex disorder. Great variety exists in the indications and techniques recommended for the surgical management of this complex. Methods: In a group of 23 prospectively selected patients (15 males and 8 females) having (CIM) with and without syringomyelia (11 patients and 12 patients respectively) during a five years period from January, 2005 to January, 2010. Cranio-cervical bony decompression alone was done in 8 patients, Cranio-cervical bony decompression with duroplasty was done in 12 patients, and Cranio-cervical bony decompression with syringo-subarachnoid shunt was done in three patients. Outcome was defined as good, fair, or bad. Results: During a mean follow-up period of 32 months, the overall outcome was good in 19 patients (83%), fair in 3 patients (13%), and bad in one patient (4%). No operative mortality or permanent post operative morbidity was encountered. Transient post operative morbidity was encountered in 6 patients (26%) namely mild temporary neurological deterioration, CSF leak, and mild wound sepsis. There were no statistically significant differences between the various decompressive approaches. Conclusion: Decompression of the cranio-cervical junction through suboccipital craniectomy (SOC) with cervical laminectomy, duroplasty, or syringo-subarachnoid shunt is the recommended surgical management option for CIM±S. Further studies utilizing larger patient volumes are necessary to confirm our recommendation.

Introduction: Chiari I malformation (CIM) is a congenital abnormality defined as downward herniation of the cerebellar tonsils through the foramen magnum. Syringomyelia is present in 30–85% of cases. Magnetic resonance (MR) imaging has increased the frequency of diagnosis of this complex disorder. Great variety exists in the indications and techniques recommended for the surgical management of this complex. Methods: In a group of 23 prospectively selected patients (15 males and 8 females) having (CIM) with and without syringomyelia (11 patients and 12 patients respectively) during a five years period from January, 2005 to January, 2010. Cranio-cervical bony decompression alone was done in 8 patients, Cranio-cervical bony decompression with duroplasty was done in 12 patients, and Cranio-cervical bony decompression with syringo-subarachnoid shunt was done in three patients. Outcome was defined as good, fair, or bad. Results: During a mean follow-up period of 32 months, the overall outcome was good in 19 patients (83%), fair in 3 patients (13%), and bad in one patient (4%). No operative mortality or permanent post operative morbidity was encountered. Transient post operative morbidity was encountered in 6 patients (26%) namely mild temporary neurological deterioration, CSF leak, and mild wound sepsis. There were no statistically significant differences between the various decompressive approaches. Conclusion: Decompression of the cranio-cervical junction through suboccipital craniectomy (SOC) with cervical laminectomy, duroplasty, or syringo-subarachnoid shunt is the recommended surgical management option for CIM±S. Further studies utilizing larger patient volumes are necessary to confirm our recommendation.

Introduction: Chiari I malformation (CIM) is a congenital abnormality defined as downward herniation of the cerebellar tonsils through the foramen magnum. Syringomyelia is present in 30–85% of cases. Magnetic resonance (MR) imaging has increased the frequency of diagnosis of this complex disorder. Great variety exists in the indications and techniques recommended for the surgical management of this complex. Methods: In a group of 23 prospectively selected patients (15 males and 8 females) having (CIM) with and without syringomyelia (11 patients and 12 patients respectively) during a five years period from January, 2005 to January, 2010. Cranio-cervical bony decompression alone was done in 8 patients, Cranio-cervical bony decompression with duroplasty was done in 12 patients, and Cranio-cervical bony decompression with syringo-subarachnoid shunt was done in three patients. Outcome was defined as good, fair, or bad. Results: During a mean follow-up period of 32 months, the overall outcome was good in 19 patients (83%), fair in 3 patients (13%), and bad in one patient (4%). No operative mortality or permanent post operative morbidity was encountered. Transient post operative morbidity was encountered in 6 patients (26%) namely mild temporary neurological deterioration, CSF leak, and mild wound sepsis. There were no statistically significant differences between the various decompressive approaches. Conclusion: Decompression of the cranio-cervical junction through suboccipital craniectomy (SOC) with cervical laminectomy, duroplasty, or syringo-subarachnoid shunt is the recommended surgical management option for CIM±S. Further studies utilizing larger patient volumes are necessary to confirm our recommendation.

SICH during childhood is rare and often devastating event. The objective of this study was to highlight the etiology, demography, hemorrhagic type, clinical features, treatment options and outc Sixty nine consecutive patients of SICH aged 18 years and below were retrospec¬tively analyzed based on clinical data and radiographic images in regard to their age, sex, symptoms, radiologic findings, treatment and ou Age of patients ranged from one month to 18 years with higher predilection in males (M: F = 1.4:1). Presenting features were symptoms of raised intracranial pressure (43%), deterioration in conscious level (28%), limb weakness (17%) and seizures (12%). In our series hematological disorders was the most common cause of hemorrhage, and was found in 34 patients (49%), followed by Arteriovenous malformations (AVMs) in 23 patients (33%), intracranial tumor in 4 patients (6% ), unknown cause in 4 patients (6%), CNS infection in 2 patients (3%) and intracranial aneurysm in 2 patients (3%). Treatment modalities consisted of: hematoma evacuation, excision, embolization or radiosurgery of AVMs, aneurysm clipping, tumor excision and conservative managem

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