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Background The additional information that transcranial Doppler can provide as part of a multimodal imaging protocol in many clinical settings has not been evaluated. Main body Transcranial Doppler is a bedside procedure used to assess cerebral blood flow velocity via cerebral circulation and pulsatility index (PI). Many diseases can lead to cerebral vessels vasospasm as in subarachnoid hemorrhage and trauma. Cerebral vessels vasospasm represented by abnormal elevation of cerebral blood flow velocity. Intracranial pressure can be monitored by pulsatility index which reflects blood flow resistance in cerebral vessels. Transcranial Doppler ultrasonography is also the unique modality for detection of micro emboli in high-risk patients. Also, it can be used for evaluation of circulatory arrest with subsequent confirmation of brain death Conclusion Transcranial Doppler ultrasonography is the only diagnostic modality that provides a reliable assessment of cerebral blood flow patterns in real time. The physiological information obtained from TCD is complementary to the anatomical details obtained from other neuroimaging modalities. TCD is relatively cheap, can be performed bedside, and allows monitoring in acute emergency settings.

BACKGROUND: Traumatic central cord syndrome was first described by Schneider and colleagues as a spinal cord injury in 1954. Other definitions were not apart from the fact of greater weakness of upper limbs than lower limbs. Surgical treatment was mentioned frequently for plateaued neurological insult. OBJECT: This study aimed to examine the functional outcome of early surgical decompression for acute traumatic central cord syndrome. METHODS: After gaining ethical approval, 37 patients with acute traumatic central cord syndrome (ATCCS) were randomized into two groups, (medical and surgical group). The medical group was treated by intravenous fluids, neurotonics, and high doses of steroids. The surgical group was treated by laminectomy of the affected levels and duraplasty with fascia lata. The American Spinal Injury Association (ASIA) impairment scale, the incidence of neuropathic pain, urinary symptoms, and hospital stay were tested. RESULTS: It has been found that both the surgical group and the conservative group had a great improvement in ASIA motor function score with a highly statistically significant difference (

Background: Traumatic brain injury remains a major cause of death and disability all over the world. In Egypt it represents a major public health problem, representing 17.2% of trauma patients. Various factors determine the prognosis after TBI, the primary insult, which is irreversible and the secondary insults which continue to evolve during the subse-quent period after trauma. Aim of Study: In this study, we examined the value of immediate post-operative head CT scans in trauma patients to assess its efficacy and role in returning back to operation room. Results: We prospectively studied 145 patients with head injury who underwent surgery at Kasr Al-Ainy Hospitals during a period of 4 months between 10/2018 and 1/2019. All patients had immediate follow-up CT within 2 hours and another follow-up within 48 hours. The results of the immediate CT were: 121 cases improved (83.4%), expected worsening in 14 patients (9.7%) out of which 5 patients had redo surgery, unexpected worsening in 8 patients (5.5%) out of which 2 patients had redo surgery and 2 patients with unexpected new fining (none of them required redo). The 48 hours CT revealed no change in 133 patients (91.%), unexpected new finding in 12 patients (8.3%) most of these changes were in patients with ASDH. Conclusion: Unexpected change in the neurological ex-amination was the single most influential factor in determining the need for redo surgery. The low-cost, meticulous neurolog-ical examination appears to be superior to a routine CT scan in determining return to the operation room.

Background: Fixation of bone flap following craniotomy is usually achieved by synthetic materials. In rural and poor funding areas, innovation for cheap, safe and applicable material is needed. Purpose: The aim is to assess our new innovative technique in bone flap fixation against traditional techniques. Patients and Methods: The study was a prospective randomized controlled study enrolled at Al-Amal Hospital and Al-Ahly Bank Hospital from 2014-2019. Forty-eight patients were randomized in the study. Group A (24 patients) underwent titanium miniplate fixation while group B (24 patients) underwent our new technique. The new technique is double J tunnels performed by craniotome on either side of the bone (flap and skull sides), then a Prolene suture is passed through the shared stem of J’ holes and secured in the wrapped side of J’s holes and tying it tightly. Both techniques were examined against fixation time, rigidity, offset and final judgment postoperatively. Result: There was no statistically significant difference in using both techniques as regard fixation time. Our new technique was not inferior to the traditional one in achieving rigidity (p > 0.05). The final postoperative assessment was as equal as that seen in miniplate fixation. Conclusion: This technique is a simple, easy, cheap and effective method of fixing craniotomy bone flap.

Background Cognitive impairment after traumatic brain injury (TBI) is a main source of morbidity for affected individuals, their family members, and their community. There are numerous serum biomarkers, which are elevated after TBI; one of these is D-dimer. Several studies have related that trauma-related coagulopathy, marked by elevated D-dimer levels, is associated with poor prognosis. Objective The aim of this study was to find if there is a correlation between elevated serum levels of D-dimer and impairment of final cognitive outcome in case suffering of Moderate TBI. Patients and method This is a prospective cohort study with a random sample of 87 patients suffering from moderate TBI. Serum level of D-dimer was requested for all cases after confirming the diagnosis of moderate TBI with post-traumatic GCS 9–12. Head trauma treatment protocols were followed according to each case diagnosis and then at the time of discharge cognitive outcome was assessed for all cases. Neurocognition was assessed by Montreal cognitive assessment-Basic (MoCA-B). Results Eighty-seven cases were included in this trial with a mean age 28 years. 48.3% of cases were treated conservatively while the remaining 51.7% needed surgical interventions for different pathologies. Seventy-five cases had elevated levels of serum D-dimer (86.2%) whereas only 12 cases have within normal levels (13.8%). A twofold increase in the serum D-dimer level was found in 41% of cases, while 34.5% of cases had three- to sixfold increases, and 10% of cases had more than sixfold increase. The mean MoCA-B score was 24 points (range 13–27). Correlating the D-dimer levels statistically with the MoCA scores, age, admission and discharge GCS, and durations of hospital stay did not show any statistical significance with any of these variables. Conclusion The role played by D-dimer in the pathophysiology of cognitive deficits and its correlation with post moderate TBI cognitive outcome was not proven.

Background: Epidural hematoma (EDH) forms about 2–3% of all head injuries in the pediatric population. We evaluated clinical data and risk factors for postoperative infarction in children younger than 2 years presented with traumatic EDH. Methods: We retrospectively reviewed and analyzed the data of 28 children with traumatic EDH operated in our institute during a period of 26 months (from December 2016 to Febuary 2019). Results: Nineteen children were boys (68%) and nine were girls (32%), the mean age was 15 months (range from 5 to 24 months). Postoperative cerebral infarction was detected in seven cases (25%). Factors could be linked to postoperative cerebral: preoperative pediatric Glasgow Coma Scale (P = 0.036), neurological deficit on admission (P = 0.023), size of hematoma (P < 0.001), time between trauma and surgery (P = 0.004), midline shift (MLS) (P = 0.001), and basal cistern compression (P = 0.004). Conclusion: Traumatic EDH in young children represents a neurosurgical challenge that needs rapid surgical intervention for the best surgical outcome. Delay in the time of surgery for more than 6 h, large hematoma volume >100 ml3, MLS >10 mm, and basal cisterns compression will push the intracranial pressure to the point of decompensation and the resultant ischemic sequel occurs.

Background: Etiologies of hydrocephalus are many and sometimes it can be attributed to be multifactorial in origin. Presence of known cause of hydrocephalus like fourth ventricular pathology may mask foramenal stenosis. Diagnosis of unilateral and bilateral stenosis of foramen of Monro should be included in the treatment plan in hydrocephalus A case report of a 9 months-old boy presented with delayed milestones of development and an increase in head circumference. The patient has been diagnosed as hydrocephalus and associated Dandy-Walker malformation. Ventriculoperitoneal shunt was inserted successfully but drained only one lateral ventricle. The association of isolated lateral ventricle with Dandy-Walker malformation is due to stenosis of foramen of Monro. Our case report is unique due to association between foramen occlusion and Dandy-Walker malformation.

Cancer is considering a major leading cause of mortality. Nanotechnology holds a gold promise to develop cancer drug delivery and treatment. The present study aimed to compare in-vitro anticancer activities of chitosan (CS) and chitosan nanoparticles (CSN) against MCF7, PC3, HCT116 and A549 cell lines. The nanoparticles physic-chemical properties were estimated by Transmission Electron Microscopy (TEM) and Fourier Transform Infrared analysis (FTIR) through size and zeta potential analysis. In the current study, the results revealed that, the average diameter and zeta potential of CSN were 116.5 nm and 6.43 mV, respectively. Subsequently, CSN showed the anticancer activity with the LC50 values of 101.28 I¼g/mL in MCF7, 367.65 I¼g/mL in PC3, 666.67 I¼g/mL in HCT116 and 681.82 I¼g/mL in A549, whereas CS gave the LC50 values of 102.67 I¼g/mL in MCF7, 694.44 I¼g/mL in PC3, 1470.59 I¼g/mL in HCT116 and 769.23 I¼g/mL in A549. This study concluded that CSN were better than those obtained from CS as anticancer agent

Objective: The aim of this study was to determine whether adding mobilization of the outer cavernous sinus membrane as a part of the approach, in large spheno-clinoidal meningiomas without cavernous sinus extension, would reduce bleeding and increase the extent of resection. Methods: This prospective randomized controlled trial was held between February 2016 and April 2017 at Cairo University Hospitals. The study recruited 94 patients with spheno-clinoidal meningiomas without cavernous sinus involvement. Patients were randomly assigned (by a computer based randomization system) into two groups; the treatment group, in which the patients received mobilization of the outer layer of the lateral wall of the cavernous sinus, prior to opening of the dura; and, the control group, in which the patients were operated by a direct opening of the dura without cavernous sinus dissection. The primary outcome of this study was the difference in the amount of blood lost during surgery between both groups of patients. The secondary outcome variables were the estimated blood loss (EBL) calculated according to Mercurelli's formula, the extent of tumor resection and the amount of blood transfused. Results: The amount of blood loss and estimated blood loss (EBL) were significantly less in the “with mobilization group” with the P value being 0.00 and 0.013, respectively. Additionally, the amount of residual tumor was compared between both the groups and it showed that the group of patients who have received mobilization of the outer cavernous sinus membrane had a higher rate of radical resection as expressed by a lower volume of residual tumor (P value 0.005). Conclusion: In large spheno-clinoidal meningiomas without cavernous sinus involvement, routine mobilization of the outer cavernous sinus membrane reduces bleeding. This helps in a better visualization of cranial nerves in a relatively avascular field as it enables the performance of neurovascular dissection in an earlier phase of surgery. It also enables a more radical resection.

The scientific importance of nanocomposites is being increased due to their improved properties. This paper introduces an experimental investigation on the relationship between the reinforcement weight fraction and compressibility of Al/Al2O3 during high energy ball milling. Scanning electron microscopy (SEM), X-ray diffraction (XRD) and transmission electron microscopy (TEM) were used to characterise the produced powder. The results showed that the grain size of milled powders was about 43 nm with a noticeable presence of agglomerates at 10 wt.% of Al2O3. By increasing Al2O3 weight fraction to 12% the decrease in grain size was very. With up to 12 wt.% of Al2O3, microhardness increases from 62 to 150 HV due to the decrease of the crystallite size. The compressibility behaviour of the nanocomposite powder was decreased slowly by increasing Al2O3 content due to work hardening on the matrix powder. Copyright 2016 Inderscience Enterprises Ltd. Scopus

Radiosurgery seems to be a very appealing option for patients having a small petrous apex meningioma and presenting with trigeminal neuralgia, presumably because of the lower risk and cost involved. The aim of this study was to analyze the results of our surgical series of petrous apex meningioma presenting with trigeminal neuralgia, and to determine the efficacy of neurosurgical treatment with regard to pain control. The procedure-related complication and morbidity rates were also evaluated.This is a retrospective study of 17 patients with a small (3 cm) petrous apex meningioma. The included patients were refractory to medical treatment for trigeminal neuralgia and were deemed as surgical candidates. Postoperatively, the patients were assessed for pain relief according to the Barrow Neurological Institute (BNI) scale. A P value of less than 0.05 was considered significant. Magnetic resonance imaging was also performed after 6 weeks to assess the radicality of resection.In a median follow-up of approximately 2 years, the study showed that 14 of the 17 (82.4%) patients had complete pain relief, with very low morbidity and no mortality, and 100% tumor control. According to the Barrow Neurological Institute (BNI) scale for the assessment of postoperative pain relief, 52.9, 23.5, 5.9, 11.8, and 5.9% of patients had grades I, II, IIIa, IIIb, and IV in terms of their pain relief, respectively.In our population of patients, surgery proved to be successful in providing symptomatic relief, with low morbidity and no mortality, and was comparable with other studies involving the minimally invasive modalities. However, these results warrant further follow-up, with recruitment of more patients, to demonstrate whether or not, surgery should be the primary choice of treatment in this subgroup of patients.