Tuberculum Sellae Meningiomas: Nuances in Treatment

Tuberculum sellae meningiomas (TSMs) represent special surgical challenge for neurosurgeons. In this review, we summarize the most common clinical manifestations, diagnostic images, surgical approaches and prognostic factors for outcome at single tertiary care teaching hospitals. Material and Methods: Prospective study was done between January 2010 and January 2017 (Minimum 24-month follow-up). Imaging and clinical data of 31 consecutive patients with TSMs were collected and analyzed. There were no exclusion criteria. Result: The majority of patients were >40 years old (22 patients;71%). There was a female preponderance 74%: 23 cases (M/F ratio was 1:3). The most common clinical presentation was visual impairment (24;77%). The mean tumor size was 3.3 cm. Thirty-one patients underwent surgical excision by different approaches. The overall visual improvement was 29% (9 of 31 patients) however visual deterioration occurred in 6.4% (2 of 31 patients). Favorable prognosis was found in patients with short preoperative visual affection (less than 6 months). This finding was statistically significant (P ≤ 0.05). Also, visual outcome had significant correlations with edema surrounded tumor: arterial encasement by the tumor and brain-tumor interface. Two patients died 3 weeks postoperatively from brain stem infarction (overall incidence of mortality 6%) while the overall incidence of morbidity was 19% (6 of 31 patients). Conclusion: The most common symptom of Tuberculum sellae meningioma is visual affection. The favorable prognosis was found in patients with short preoperative visual affection (less than 6 months). Also;visual prognosis had significant correlations with peritumoral edema, arterial encasement by the tumor, and brain-tumor interface.

Intracranial Fungal Infections: Overview from Two Large Tertiary Hospital in Upper Egypt and Literature Review

Purpose: Fungal infections of the central nervous system (CNS) are potentially lethal conditions with high morbidity and mortality. In this review, we summarise the most common clinical manifestations, diagnostic methods, and treatment strategies for intracranial fungal infection at two tertiary care teaching hospitals. Material and methods: Prospective hospital study is carried out at Department of Neurosurgery;Assiut and Suhaj University Hospitals between January2010 to January 2018 (Minimum 12-months follow-up). Radiographs and hospital data of 74 patients with proven intracranial fungal infections were gathered and analyzed. There were no exclusion criteria: age, gender, clinical presentations, immunity status, radiological findings, laboratory, and microbiological data, types of management and outcome. In surgically treated patients, diagnosis was confirmed by pathologic evaluation. Gathered data were coded and entered into a computer and analyzed using SPSS version 22. Results: The greatest number of the patients had 40 to 60 years old (49;66%) and the mean age was 44 years. There was an overwhelming male patient’s ranged preponderance 66%;49 cases. Sixty-three patients (85%) were immunosuppressed;11 cases (15%) were immunocompetent. The most common causes of immunosuppression were diabetes 27 patients;43%, on chemotherapeutic agents 19 patients;31%, on corticosteroid 16 patients;25% and AIDS in one patient;1%. Five different fungal types were identified but Cryptococcus spp. was the most common cause of CNS fungal infection, occurring in 39 patients (53%). This was followed by Candida spp. in 14 patients (19%), Aspergillus in 11 patients (15%), Blastomyces in 7 patients (9%) and Coccidiosis in 3 patients (4%). Headache was the most common presenting symptom, occurring in 33 patients (45%). Other relatively common symptoms were nausea or vomiting 11 patients (15%), fever 10 patients;(13%), seizures 9 patients (12%), acute mental status changes 8 patients;(11%) and stroke like Symptoms 3patients (4%). Different surgical procedures were done. Stereotactic biopsy is in 19 patients (deep;located in an eloquent region of the brain or multiple small lesion) or excision in 38 patients (cortical, relatively accessible regions of the brain), and CSF shunting in 17 patients. All patients received parenteral and, in some cases, oral antifungal chemotherapy in addition to surgical therapy. Overall mortality was 52.7% (39 deaths). An additional 8 surviving patients exhibited permanent morbidity due to neurological deficits and seizure disorders. Conclusion: This prospective population study demonstrates an insight into the intracranial fungal infection and management. CNS fungal infections have increased in frequency, particularly in immunocompromised patients;most infections are caused by Cryptococcus spp. Diabetes was the most common cause of immunosuppression and headache was the most common symptom at presentation. CNS fungal infection is still associated with a high mortality and morbidity. Prompt diagnosis;early and appropriate medical and surgical management are fundamental to optimize the outcome.

Epidemiological Features of Patients with Craniomaxillofacial Fractures: A Single Centre Study

Purpose: It has been shown that cranial injuries associated with facial fractures may cause a great risk of mortality and neurological morbidity, which mainly occurs in young adults. Various studies have been carried out in various countries to study the epidemiology of the cranio maxillofacial injuries but the studies from Egypt are few. The aim of this study was therefore to assess the prevelance, etiology, type of injury, and site of fractures among patient attending Assiut University Hospitals. Material and Methods: Retrospective hospital study was carried out at Trauma unit, Assiut University Hospitals (Single Tertiary Hospital) between January 2010 and December 2017. Radiographs and hospital data of 1745 patients with craniomaxillofacial trauma were gathered and analyzed. The identified fractures, such as, age, gender, etiology of injury, and anatomical sites of fractures were classified as: frontal/skull base, naso-orbital, maxilla, zygoma, and mandible. According to GCS, patients were classified into 3 grades: mild, moderate and severe. Gathered data was coded and entered into a computer and analyzed using SPSS version 22. Result: Overall prevalence of cranio maxillofacial injuries was 3%. Age ranged from 1 - 90 with mean ± SD 25.75 ± 15.5. The greatest number of the patients had 18 to 40 years old (48.4%) and most of them were male (M/F ratio was 7:1). The most prevalent causes of the trauma in this study were the road traffic accidents (67.7%) and accidental fall (15%), respectively. Firearm injuries accounted for fractures in 86 patients (4.9%). The most common bone fracture among the patients was the mandibular bone (47.7%). 837 patients (48%) required surgical intervention. Conclusions: This retrospective population study demonstrates an insight into the demographics and fracture patterns in craniomaxillofacial trauma patients. The most common etiology of craniomaxillofacial injury was road traffic accidents followed by falls and assaults, suggesting that interventions addressing the prevention of this mechanism, and treatment of the associated injury patterns, have not been sufficient and require to be revised. The majority of victims were young adult males between the ages of 18 to 40 years. The mandibular bone and maxilla were the most common sites of fracture.