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Background: Arising from different anatomical structures of the spine, chronic low back pain is one of the leading causes of disability, and its management is still controversial. Thus, appropriate and effective management of chronic low back pain requires a precise diagnostic tool in order to target pain generators. Therefore, the role of diagnostic injection in predicting the outcome of surgical treatment of chronic low back pain and lower limb radicular pain need to be evaluated in order to guide the surgeon, especially in case of unclear pathoanatomical features. Thus, the aim of this study was to assess the predictive value of lumbar spine diagnostic injections in surgical outcome in patients with chronic low back pain and lumbar radiculopathy. Patients and methods: This study included 30 patients complaining of chronic low back pain and/or lumbar radiculopathy who underwent lumbar spine surgery following positive diagnostic injections. The pre- and postoperative assessments consisted of a general neurological examination, evaluation of the Oswestry disability index, and a visual analog scale. Results: This prospective non-controlled study was conducted on 30 patients complaining of chronic low back pain and/or lumbar radiculopathy. The mean age was 42.60 ± 8.27 years with a range of 24.0–62.0 years. The visual analog scale decreased significantly from preoperative mean value of 8.26 ± 0.79 to postoperative mean value of 1.97 ± 0.92; with almost two-thirds of the patients experienced more than 75% pain reduction. The Oswestry disability index decreased significantly from preoperative mean value of 34.13 ± 4.88 to 11.47 ± 3.36 after surgery in the whole sample. The post-selective nerve root block visual analog scale was significantly correlated to the postoperative visual analog scale, while the postoperative Oswestry disability index was not significantly associated with the post-selective nerve root block visual analog scale. Conclusion: The use of lumbar selective nerve root block and lumbar provocative discography for patients with chronic low back pain and radiculopathy and equivocal radiological findings can improve surgical outcomes regarding pain intensity and spine functional outcomes. Diagnostic selective nerve root block can predict the postoperative pain relief. [ABSTRACT FROM AUTHOR]

Background: Large intraventricular tumors (IVTs) impose technical and surgical challenges, due to their enormous sizes, mass effect, vast extensions, and vascularity. Objective: The authors aim at presenting their results, clinical outcomes, and the surgical strategies in the management of large IVTs through transcortical approaches. Methods: A prospective trial was conducted at the Main Hospital of Alexandria University, Egypt, between August 2018 and October 2020 on 20 patients harboring IVTs larger than 5 cm or bilaterally represented. The variables evaluated included the extent of resection, postoperative neurological deficits, blood loss, surgical approaches, intraoperative challenges, complications, adjuvant therapies, Glasgow Outcome Scale, hydrocephalus, and cerebrospinal fluid (CSF) diversion. Results: The study included 20 cases (9 males and 11 females). Mean age at diagnosis was 16.1 years (range 1–45). Mean follow-up was 12 months (range 9–26). Primary tumor locations were ventricular body, atrium, temporal horn, and frontal horn in 11, 5, 3, and 1 cases, respectively. Main pathologies were central neurocytomas (7 patients/35%), ependymomas (3 patients/15%), and subependymal giant cell astrocytoma (SEGA) (3 patients/15%). Excision was gross total (n = 19) and near-total (n = 1). Significant intraoperative bleeding (n = 6). Postoperative minor intraventricular hemorrhage (n = 6), subdural collections (n = 8), hydrocephalus (n = 9), memory affection (n = 4), and motor deficits (n = 4). Postoperative Glasgow Outcome Scale of 5/5 (n = 20), no mortalities were recorded. preoperative seizures (n = 7), new onset postoperative seizures (n = 2). Conclusion: Surgical approaches to large tumors of the lateral ventricles should be tailored to the variability of tumor locations, dimensions, extensions, and the individual morbid anatomy, in addition to the surgeon's experience and preferences. Trans-cortical approaches can provide safe surgical corridors to tackle these challenging subtypes of IVTs with good clinical outcomes, tumor resectability rates, and seizure control. [ABSTRACT FROM AUTHOR]

Acute intracranial subdural hematoma (ASDH) is commonly associated with a grave prognosis citing a high incidence of morbidity and mortality. The parameters to decide on surgical evacuation of the hematoma are sometimes controversial. In this study, we theorized that the ratio between maximal hematoma thickness and midline shift would be varied by associated intrinsic brain pathology emanating from the trauma and would thus objectively evaluates the prognosis in ASDH. The records of patients diagnosed with ASDH who were submitted to surgical evacuation through a craniotomy were revised. Data collected included basic demographic data, preoperative general and neurological examinations, and radiological findings. The maximal thickness of the hematoma (H) on the preoperative CT brain was divided by the midline shift at the same level (MS) formulating the H/MS ratio. Postoperative data obtained included Glasgow Coma Scale (GCS), Glasgow Outcome Scale (GOS), and follow-up period. Sixty-seven eligible patients were included in the study, of which 53 (79.1%) patients were males. Mean age was 34 years. The H/MS ratio ranged from 0.69 to 1.8 with a mean of 0.93. Age above 50 years (P = 0.0218), admission GCS of less than 6 (0.0482), and H/MS ratio of 0.79 or less (P = 0.00435) were negative prognostic factors and correlated with a low postoperative GCS and GOS. H/MS ratio is a useful prognostic tool in patients diagnosed with ASDH and can be added to the armamentarium of data to improve the management decision in this cohort of patients. [ABSTRACT FROM AUTHOR]