Abstract Background: Endoscopic transnasal skull base surgery had started long time ago in different centers around the world for excision of skull base lesions with good results and more cost effectiveness. The aim of this study is to discuss our early results in endoscopic skull base surgery and the development of the learning curve. Patients and Methods: We analyzed our experience regarding 25 patients presented to us in Neurosurgery Department, Assiut University Hospital, Assiut University, Assiut, Egypt in a period of 3 years (2015, 2016, 2017) and operated by endoscopic transnasal approach. All patients signed an informed consent. Results: With the highest percentage was pituitary adenoma 56%, pituitary apoplexy 12%, craniopharyngioma 12%, CSF rhinorrhea 12%, Planum sphenoidal meningioma 4% and suprasellar granuloma 4%. 88% of patients were operated without complications, 8% mortality rate postoperative, 12% complication rate and 76% complete improvement postoperative. Conclusion: Endoscopic skull base surgery is a safe approach to the skull base that needs a good experience, practice and good anatomical knowledge. Teamwork between a Neurosurgeon and ENT surgeon is a must for patient safety.

Abstract Chronic Subdural Hematoma (CSDH) is one of the most common types of intracranial hemorrhage, and the prognosis is good if treated properly. The standard treatment for CSDH is surgical evacuation. Various surgical procedures are used such as burr holes evacuation, twist-drill craniostomy, and craniotomy. Our aim is to evaluate the feasibility and safety of twist dill as a first-choice treatment in evacuation of CSDH in comorbid patients. Methods: This study is a prospective analysis of CSDH evacuation using two twist drill craniostomy holes and irrigation conducted on 21 patients with different comorbidities in Assuit University Hospital between May 2017 and May 2018. Results: The overall postoperative clinical improvement was 95.2%. The operative time was less than 10 minutes in 71.4% of the patients. 4 patients showed residual collection in the post-operative CT (19%). Pneumocephaly was detected in 2 patients (9.5%). Postoperative seizures occurred in 2 patients (9.5%), and subarachnoid hemorrhage was detected in one patient (4.7%). Conclusion: This approach is a new modification of twist drill craniostomy which can decrease the postoperative residual and recurrence rates and also still a minimally invasive and lifesaving technique in patients with different comorbidities.

Abstract Chronic Subdural Hematoma (CSDH) is one of the most common types of intracranial hemorrhage, and the prognosis is good if treated properly. The standard treatment for CSDH is surgical evacuation. Various surgical procedures are used such as burr holes evacuation, twist-drill craniostomy, and craniotomy. Our aim is to evaluate the feasibility and safety of twist dill as a first-choice treatment in evacuation of CSDH in comorbid patients. Methods: This study is a prospective analysis of CSDH evacuation using two twist drill craniostomy holes and irrigation conducted on 21 patients with different comorbidities in Assuit University Hospital between May 2017 and May 2018. Results: The overall postoperative clinical improvement was 95.2%. The operative time was less than 10 minutes in 71.4% of the patients. 4 patients showed residual collection in the post-operative CT (19%). Pneumocephaly was detected in 2 patients (9.5%). Postoperative seizures occurred in 2 patients (9.5%), and subarachnoid hemorrhage was detected in one patient (4.7%). Conclusion: This approach is a new modification of twist drill craniostomy which can decrease the postoperative residual and recurrence rates and also still a minimally invasive and lifesaving technique in patients with different comorbidities.

Abstract Chronic Subdural Hematoma (CSDH) is one of the most common types of intracranial hemorrhage, and the prognosis is good if treated properly. The standard treatment for CSDH is surgical evacuation. Various surgical procedures are used such as burr holes evacuation, twist-drill craniostomy, and craniotomy. Our aim is to evaluate the feasibility and safety of twist dill as a first-choice treatment in evacuation of CSDH in comorbid patients. Methods: This study is a prospective analysis of CSDH evacuation using two twist drill craniostomy holes and irrigation conducted on 21 patients with different comorbidities in Assuit University Hospital between May 2017 and May 2018. Results: The overall postoperative clinical improvement was 95.2%. The operative time was less than 10 minutes in 71.4% of the patients. 4 patients showed residual collection in the post-operative CT (19%). Pneumocephaly was detected in 2 patients (9.5%). Postoperative seizures occurred in 2 patients (9.5%), and subarachnoid hemorrhage was detected in one patient (4.7%). Conclusion: This approach is a new modification of twist drill craniostomy which can decrease the postoperative residual and recurrence rates and also still a minimally invasive and lifesaving technique in patients with different comorbidities.

Background Neural tube defects (NTDs) occur because of a defect in the neurulation process. Meningocele and meningomyelocele are the most common forms of spinal dysraphism. Most cases of myelomeningocele and meningocele can be closed by direct repair, but sometimes a problem is faced intraoperatively during skin closure in some cases. The aim of our work is to describe and make a plan for proper operative management during the clinic visit for ideal repair and closure of the back skin defect. This depends on the area of the defect measured preoperatively to close the defect by properly designing the method of closure by either a flab or a graft. Patients and methods This is a prospective hospital‑based study that included 60 patients. According to the defect size (we measured the defect preoperative and intraoperative by sterile ruler), we classified the patients into three groups. The first group was closed directly by simple repair, the second group was closed by local skin fasciocutaneous flap (either by two rhomboid flaps or one rotational flap), and the third group was closed by skin graft (split‑thickness skin graft) owing to a large defect with immobile skin‑for‑skin flap. Results In 75% of cases, closure was done by direct repair, in 16.7% by rotational flap, and in 8.3% by skin graft. According to the size of the defect, we found that a defect with a total surface area of 18 cm2 and less was closed by simple direct repair, that with a total surface area of 18–80 cm2 was closed by rotational flap, and that with a total surface area of more than 80 cm2 was closed by a skin graft. Conclusion Good preoperative assessment is needed for every patient with spina bifida skin defect. Choice of coverage depends on the surface area and the extent of the lesion, which help in getting the best results for skin repair.

Background Neural tube defects (NTDs) occur because of a defect in the neurulation process. Meningocele and meningomyelocele are the most common forms of spinal dysraphism. Most cases of myelomeningocele and meningocele can be closed by direct repair, but sometimes a problem is faced intraoperatively during skin closure in some cases. The aim of our work is to describe and make a plan for proper operative management during the clinic visit for ideal repair and closure of the back skin defect. This depends on the area of the defect measured preoperatively to close the defect by properly designing the method of closure by either a flab or a graft. Patients and methods This is a prospective hospital‑based study that included 60 patients. According to the defect size (we measured the defect preoperative and intraoperative by sterile ruler), we classified the patients into three groups. The first group was closed directly by simple repair, the second group was closed by local skin fasciocutaneous flap (either by two rhomboid flaps or one rotational flap), and the third group was closed by skin graft (split‑thickness skin graft) owing to a large defect with immobile skin‑for‑skin flap. Results In 75% of cases, closure was done by direct repair, in 16.7% by rotational flap, and in 8.3% by skin graft. According to the size of the defect, we found that a defect with a total surface area of 18 cm2 and less was closed by simple direct repair, that with a total surface area of 18–80 cm2 was closed by rotational flap, and that with a total surface area of more than 80 cm2 was closed by a skin graft. Conclusion Good preoperative assessment is needed for every patient with spina bifida skin defect. Choice of coverage depends on the surface area and the extent of the lesion, which help in getting the best results for skin repair.

Background Neural tube defects (NTDs) occur because of a defect in the neurulation process. Meningocele and meningomyelocele are the most common forms of spinal dysraphism. Most cases of myelomeningocele and meningocele can be closed by direct repair, but sometimes a problem is faced intraoperatively during skin closure in some cases. The aim of our work is to describe and make a plan for proper operative management during the clinic visit for ideal repair and closure of the back skin defect. This depends on the area of the defect measured preoperatively to close the defect by properly designing the method of closure by either a flab or a graft. Patients and methods This is a prospective hospital‑based study that included 60 patients. According to the defect size (we measured the defect preoperative and intraoperative by sterile ruler), we classified the patients into three groups. The first group was closed directly by simple repair, the second group was closed by local skin fasciocutaneous flap (either by two rhomboid flaps or one rotational flap), and the third group was closed by skin graft (split‑thickness skin graft) owing to a large defect with immobile skin‑for‑skin flap. Results In 75% of cases, closure was done by direct repair, in 16.7% by rotational flap, and in 8.3% by skin graft. According to the size of the defect, we found that a defect with a total surface area of 18 cm2 and less was closed by simple direct repair, that with a total surface area of 18–80 cm2 was closed by rotational flap, and that with a total surface area of more than 80 cm2 was closed by a skin graft. Conclusion Good preoperative assessment is needed for every patient with spina bifida skin defect. Choice of coverage depends on the surface area and the extent of the lesion, which help in getting the best results for skin repair.

Background Neural tube defects (NTDs) occur because of a defect in the neurulation process. Meningocele and meningomyelocele are the most common forms of spinal dysraphism. Most cases of myelomeningocele and meningocele can be closed by direct repair, but sometimes a problem is faced intraoperatively during skin closure in some cases. The aim of our work is to describe and make a plan for proper operative management during the clinic visit for ideal repair and closure of the back skin defect. This depends on the area of the defect measured preoperatively to close the defect by properly designing the method of closure by either a flab or a graft. Patients and methods This is a prospective hospital‑based study that included 60 patients. According to the defect size (we measured the defect preoperative and intraoperative by sterile ruler), we classified the patients into three groups. The first group was closed directly by simple repair, the second group was closed by local skin fasciocutaneous flap (either by two rhomboid flaps or one rotational flap), and the third group was closed by skin graft (split‑thickness skin graft) owing to a large defect with immobile skin‑for‑skin flap. Results In 75% of cases, closure was done by direct repair, in 16.7% by rotational flap, and in 8.3% by skin graft. According to the size of the defect, we found that a defect with a total surface area of 18 cm2 and less was closed by simple direct repair, that with a total surface area of 18–80 cm2 was closed by rotational flap, and that with a total surface area of more than 80 cm2 was closed by a skin graft. Conclusion Good preoperative assessment is needed for every patient with spina bifida skin defect. Choice of coverage depends on the surface area and the extent of the lesion, which help in getting the best results for skin repair.

Abstract Background data: Lumbar spinal stenosis is common in elderly and obese patients. Surgical intervention should be considered only after all conservative treatment options have been proven unsuccessful. wide laminectomy was the gold standard of treatment, but surgical failures have been reported. Recently, a less invasive decompressive surgical procedures have emerged as an alternative technique. Purpose: to compare between the unilateral laminotomy approach and conventional laminectomy approach for the treatment of lumbar canal stenosis, regarding clinical outcomes. Study design: this is a prospective clinical randomized controlled study. Patients and methods: This study included 30 patients with lumbar canal stenosis. 15 patients underwent unilateral laminotomy approach (group A), while the other 15 patients underwent conventional laminectomy approach (group B). Surgical operative time, blood loss and hospital stay were recorded. Clinical outcomes have been assessed by Visual Analogue Scale (VAS) of leg pain and Oswestry Disability Index (ODI). Patients were followed up for 1 year postoperatively. Results: Male: female ratio was 12:18 patients. The mean age was 52.5±6.62 years in group (A), and 52.2±7.24 years in group (B). The mean operative time was 73.5±14.54 minutes in group (A) and 85.5±17.07 minutes in group (B). Less blood loss was recorded with group-A (127±37.43 ml) than group-B (152±50.95 ml). Three patients suffered unintended durotomy in both groups and no postoperative C.S.F leak occurred. Marked reduction of VAS and ODI was achieved in both groups at one year follow up without statistically significant difference. Conclusion: Unilateral laminotomy approach used for bilateral neural compression is an effective technique for treatment of lumbar canal stenosis in comparison to conventional laminectomy approach.

Abstract Background data: Lumbar spinal stenosis is common in elderly and obese patients. Surgical intervention should be considered only after all conservative treatment options have been proven unsuccessful. wide laminectomy was the gold standard of treatment, but surgical failures have been reported. Recently, a less invasive decompressive surgical procedures have emerged as an alternative technique. Purpose: to compare between the unilateral laminotomy approach and conventional laminectomy approach for the treatment of lumbar canal stenosis, regarding clinical outcomes. Study design: this is a prospective clinical randomized controlled study. Patients and methods: This study included 30 patients with lumbar canal stenosis. 15 patients underwent unilateral laminotomy approach (group A), while the other 15 patients underwent conventional laminectomy approach (group B). Surgical operative time, blood loss and hospital stay were recorded. Clinical outcomes have been assessed by Visual Analogue Scale (VAS) of leg pain and Oswestry Disability Index (ODI). Patients were followed up for 1 year postoperatively. Results: Male: female ratio was 12:18 patients. The mean age was 52.5±6.62 years in group (A), and 52.2±7.24 years in group (B). The mean operative time was 73.5±14.54 minutes in group (A) and 85.5±17.07 minutes in group (B). Less blood loss was recorded with group-A (127±37.43 ml) than group-B (152±50.95 ml). Three patients suffered unintended durotomy in both groups and no postoperative C.S.F leak occurred. Marked reduction of VAS and ODI was achieved in both groups at one year follow up without statistically significant difference. Conclusion: Unilateral laminotomy approach used for bilateral neural compression is an effective technique for treatment of lumbar canal stenosis in comparison to conventional laminectomy approach.