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BACKGROUND: Cauda equina syndrome (CES) is a rare but an important emergent state caused by compression of lumbosacral nerve roots. Conventionally, the treatment of CES patients was total laminectomy and discectomy. It has been reported that minimally invasive lumbar microscopic discectomy (MIS-LD) led to outcomes comparable to conventional open microdiscectomies, with fewer complications. OBJECTIVE: This IS study aimed to assess the effectiveness of minimally invasive lumbar microscopic discectomy for treatment of huge or ruptured lumbar disc herniation (LDH) causing CES. METHODS: This is observational retrospective case series of 12 patients treated for CES due to huge/ruptured LDH with MIS-LD. Patient's demographics and outcomes included visual analogue scale (VAS) and Medical Research Council (MRC) grading scale for low back pain (LBP), and sciatica, and lower limbs motor power assessment, respectively. Oswestry disability index (ODI) for pain and weakness as functional score. Postoperative follow up continued for 18 months to evaluate recovery of sciatica, motor weakness, urinary/bowel functions, saddle area sensory changes and sexual dysfunction. RESULTS: All patients were males, aged 28-59 years with mean age ± standard deviation (SD) of 43.14±4.2 years. Operative time ranged from 90minutes-3hours with mean time ± SD of 132.86±35minutes. Sciatica improved immediately, urinary and bowel functions recovered completely within weeks in all patients (100%), lower extremity weakness improved after 1-3 months in 11 patients (92%), and sexual dysfunction improved from 8-10 weeks in all patients (100%). Finally, saddle area sensation returned to normal after six months in all affected patients (100%). CONCLUSION: Minimally invasive lumbar microscopic discectomy is effective and efficient procedure for treatment of CES caused by huge/ruptured LDH with good recovery of motor power, full control of urinary, bowel and sexual functions, and normal saddle sensation, without surgical side effects. [ABSTRACT FROM AUTHOR]

Background: Seizures are the most common & most serious side effect of cranial surgery. The latter condition requires chronic treatment with Antiepileptic drugs (AEDs) and comes with relevant socioeconomic sequelae. The routine prophylactic use of AEDs for people undergoing tumor resection has remained controversial due to the risk of postoperative seizures. Some Neurosurgeons are advocates to the use of AEDs to reduce the risk of these seizures. Objective: To evaluate the efficacy of prophylactic AEDs routinely in brain tumor patients without previous history of seizures. Primary objective has been to identify the efficacy of AEDs in perioperative seizure prophylaxis. Secondary objective has been to highlight the most common type of post-operative AEDs. Methods: All available studies from 2000-2021 including randomized or non-randomized clinical trials, prospective or retrospective observational cohort studies, and case series of six or more cases that address these criteria have been collected. Results: Our search concluded that the most common type of post-operative seizure is the Early seizure which is of total 87 patients representing 12.3% of seizure reported patients, yet when comparing the P-value between the Early & late seizure it has a P-value of 0.415 which is nonsignificant rendering the comparison redundant. The Most common types of AED used are Phenytoin (PHT) 89 (71.8%) & Levetiracetam (LEV) 109 (81.8%). To measure the efficacy of AEDs two groups of patients with no history of AED administration or seizures preoperatively were created, one the control group of 268 participants were not administered AEDs postoperatively only 32 (11.94%) of them suffered from seizures postoperatively. The other group of 171 participants were administered the AEDs postoperatively only 25 (14.62%) of these participants suffered from postoperative seizure. Comparing both of these results statistically it had a P-value of 0.416 which is non-Significant statistically. On interpreting these results was that the AED have no influence in controlling the seizures. Conclusion: Postoperative seizures are one of the main complications of brain tumor surgery. Neurosurgeons have a strong belief more of tradition that preventing seizures with Anti- Epileptic Drugs (AEDs) as a sort of seizure prophylaxis is not only effective but also necessary. Finally, there is not enough evidence of sufficient quality available to suggest that antiepileptic drugs AEDs treatment can or cannot be recommended to reduce Post-craniotomy seizures. [ABSTRACT FROM AUTHOR]

Background: Although relatively infrequent, neurological injury is a much dreaded complication in spine surgery and has the potential to result in serious postoperative motor and sensory deficits. As a result of these surgical challenges, intraoperative neuromonitoring (IONM) has gained favorable grounds in facilitating maximal tumor resection andminimizing neurologicmorbidity. Aim and Objectives: to review the efficacy of intraoperative neurophysiological monitoring (IONM) on post operative outcomes preventing neurological injury, predicting post operative neurological deficit and its effect on intraoperative surgeon's decision making, and to know if it is beneficial or not in intramedullary spinal cord tumors surgeries in adults. Subjects and Methods: This was observational studies and non randomized controlled studies. our patients were followed up according to this schedule (immediate post operative, first day, three days, first month, three months, six months, one year post operative) and the assessment were done by using Oxford grading system. Result: Regarding neurological status by clinical examination at last follow up, Improved in 72, transient worsening in no cases, no change in 12 cases and progression in 17 cases, Conclusion. Conclusion: our systematic review of the literature indicates that there is strong evidence that multimodality neuromonitoring is sensitive and specific for detecting intraoperative neurologic injury during spine surgery. Although the level of evidence supporting the conclusion that intraoperative neuromonitoring reduces the rate of new or worsening neurologic deficits is low, the available evidence does consistently support this conclusion. [ABSTRACT FROM AUTHOR]

Background: most of adults with Diffuse Low Grade Gliomas (DLGGs) are diagnosed with an average age of 39 years and the diagnosis is often made around fully functioning individuals. Currently extent of resection (EOR) is a generally known variable that impacts overall survival (OS), progression free survival and malignant transformation in these gliomas. Aim of the study: this study aimed to evaluate the risks and benefits of maximizing the extent of resection of DLGGS, while preserving neurological function. Methodology and Materials: this was a prospective observational study of group of consecutive 20 patients with initial imaging diagnosis of supratentorial DLGGs. Preoperatively planned for maximal resection even if presuming the proximity of these lesions to eloquent cortex and their relative diffuse nature on imaging. Results: 40 % were near eloquent area and 30 % at eloquent areas. GTR achieved in 10% and STR in 65%. Pre-operative Karnofsky Performance Scale (KPS) was 100 in 10%, 90 in 65%, 72 hours post-operative 70 in 60%. During the first 6 months of follow-up KPS was 100 in 60% of the study cohort while only one patient (5%) died. After 6 months KPS was 100 and represented 95% of the whole study. LOS was the longest (4-16 days) in near eloquent and shortest in eloquent (5-8 days). 30% had pre-operative uncontrolled seizures, which cured post-operative, 50% stopped AED within a year. Average back to work period was 2.5 for eloquent, near eloquent 2.8 and non-eloquent 2.6 months. Conclusion: careful pre-surgical planning based on proper reviewed history, recent imaging techniques and utilizing up-to-date intra-operative technology is helping to maximize safe surgical resection, while saving patient function and quality of life. [ABSTRACT FROM AUTHOR]