Abstract Background: Scoliosis is a complex musculoskeletal torsional deformity of spine that includes: Lateral curvature in the anterior-posterior plane with a Cobb angle greater than 10 degrees, Angulation in the sagittal plane, or Rotation in the transverse plane. Scoliosis classified into neuromuscular, idiopathic, or congenital. Radiological evaluation is done by plain radiography, computed tomography (CT), and magnetic resonance (MR). We aimed to evaluate patients with idiopathic kyphoscoliosis who underwent a freehand posterior approach for scoliosis correction through transpedicular screws fixation. Setting: Al-Azhar University Hospitals. Subjects and Methods: Study was performed on 12 patients with idiopathic kyphoscoliosis who underwent a freehand posterior approach for scoliosis correction through transpedicular screws fixation in Al-Azhar University Hospitals between 2015 to 2018 & follow up for one year. Results: Early outcome showed improved Cobb’s angle and coronal balance significantly after surgery. Correction is 95% in 2 cases (17%), 80% correction in 8 cases (66%), 60% correction in 2 cases (17%). 2 cases have CSF leakage which improved with conservative treatment. Late follow-up shows improvement of patient deformity and cosmetic appearance to the degree of patient satisfaction occur in 7 cases (58%) associated with high SRS-30 total scores. However, assessment of the pain in comparison to preoperative assessment show improvement of pain in 4 cases (33%), persistent in 4 cases (33%), appear in 4 cases (33%). Conclusion: Freehand one stage correction management of idiopathic kyphoscoliosis through the posterior approach is a safe and effective for near-total correction of deformity with a good outcome with minimal complications.

Abstract Introduction: Lumbar and sciatic pain are frequent motives of disability in military people in Mali. As spine surgery isn’t recognized enough, our study aims to analyze etiologies, epidemiology, clinical features and surgical standards in order to improve troop abilities. Methodology: Our descriptive and retrospective study has included 31 operated military patients who underwent medical or surgical procedures between 2010 and 2018 in the Military Neu rology/Neurosurgery Unit and Mère-Enfant Hospital Neurosurgery department. Results: Among 553 seen in consultation, fifty percent were between 30 and 50 years old. Main motive was sciatic pain (65.5%). Seventy eight per cent of our patients were field militaires and sub-officers, and 83.2% were males. All of them have benefited a CT scan or MRI with medical treatment in rheumatology or neurology. Thirty-one patients underwent spine surgery and were included in the study, so 6% (mean age: 43.52 years, 90.3% males). Lumbar spine surgery represented 54.8% of cases with lumbar canal stenosis in 64.5% of cases. It appeared that spondylolisthésis with isthmic fracture was frequent (12.9%), and traumatic cervical spine fractures were dominant in 2012. Instrumented arthrodesis was performed for 41.9% of patients, lumbar discectomy for 32.3% and laminectomies for 22.6%. Degenerative etiology was found in 77.4% of cases and we’ve noticed a good outcome in 93.5% of operated cases. Conclusion: Spinal pathology in military people in Mali is in relation with training, weight carrying and transport conditions on tough terrain. Traumatic traffic injuries are the most common even in war time.

Abstract We describe three patients with severe disabling symptoms of unilateral dehiscence of the superior semicircular canal (DSSC) who had surgical treatment. Each patient underwent a unilateral subtemporal extradural approach with resurfacing the DCCS. In all 3 patients, all symptoms were completely resolved and remained symptom free on the long term. There were no post operative complications. Only one patient experienced a temporary CSF hypotension syndrome and some dizziness. The pseudo-conductive hearing loss improved or resolved in all patients. Surgical treatment should be considered in patients with severe, disabling DSSC symptoms. Surgical resurfacing of the DSSC is a safe and rewarding surgical technique. The long term success rate regarding the elimination of the pseudo-conductive hearing loss and resolution of vestibular symptoms outweigh the potential surgical risks of this technique in these patients.

Abstract Introduction: Spinal schwannomas also known as neurinomas are often benign slow growing lesion that may develop from Schwann cells of the spinal roots, it is a nerve sheath tumor. The authors reported a case of a patient presenting a hyperalgesic lumbosciatica symptomatic of a spinal schwannoma.Observation: A 36-year-old female patient, with a history of asthma under treatment was admitted to our department because of one year lasting of an intermittent fashion bilateral L5 hyperalgesic lumbosciatica. The initial examination has shown back muscles contractures and a segmental deficit of the right lower limb in L5 and S1, but no genital or sphincter disorders were noted. The lumbosacral CT scan was without particularity but the magnetic resonance imaging (MRI) revealed an intradural, extra medullary lesion at the level of L1-L2. A monobloc resection of the lesion was done. The follow-up is good. Pathology concluded in schwannoma WHO grade I classification. Conclusion: Lumbar neurinoma that grows slowly is most often manifested by a radiculalgia often hyperalgesic and disabling. MRI is the examination of choice to make the diagnosis and complete removal is possible.

Abstract Objective: Tuberculum sellae meningiomas constitute about 5% - 10% of intracranial meningiomas. They are difficult to treat, owing to their close association with the optic nerves, chiasma, and major cerebral arteries. This retrospective study aims to report on the clinical outcome after transcranial approach for treatment of tuberculem sellae meningiomas at our hospital. Patients and Methods: We reviewed patients with tuberculem sellae meningiomas and underwent transcranial surgical approaches for their lesions at Sohag university hospitals over a 4 years period starting from January 2018. The patients’ clinical and radiological data, operative details, degrees of tumor removal, outcomes and complications were reported. Results: There were 17 patients with tuberculem sellae meningiomas with a mean age of 46.3 years. Female patients constituted 70% of cases. Pterional approach was used in 59% of cases and unilateral subfrontal approach was used in 41% of cases. Gross total tumor removal was achieved in 82% of cases. Visual acuity improved in 47%, remained unchanged in 41%, and worsened in 5.9% of patients. Transient post-operative diabetes inspidus and post-operative haematoma in tumor bed each occurred in 5.9% of patients. Conclusion: Transcranial removal of tuberculum sellae meningioma is still considered the standard approach, with high rate of gross total resection and better visual outcome and low mortality and morbidity.

Abstract A common pathology that causes axial and/or radicular pain is cervical degenerative spine. It has the potential to cause myelopathy. The majority of cases necessitate surgical decompression and sagittal balance correction; surgery may be performed at multiple levels of the cervical spine. Typically, during decompression, the degenerated discs are replaced and the spine is fused, and it has been recommended to restore the lordotic curve during the procedure to avoid any axial pain post-operatively. We followed our patients who had multiple level cervical spine decompression with fusion and monitored their axial pain after correction or in the absence of correction of the normal lordosis in the early post-operative period. When various levels of degenerative cervical spine are treated, it appears that axial pain does not improve in the immediate or early postoperative term.

Abstract Purpose: Is to evaluate the accuracy of fused 3D time-of-flight (TOF) MR angiography and 3D Steady-State sequence (FIESTA) versus 3D contrast-enhanced T1 weighted images in evaluation of neurovascular compression via an inter-observer agreement protocol. Methods: Patients presented with trigeminal neuralgia, tinnitus, or facial hemispasm were examined using 3D-TOF-MRA,3D-FIESTA, and 3D contrast-enhanced T1WI of the cerebellopontine angle to assess neurovascular compression. Two independent readers assessed the location, signal alteration, offending vascular structure, and grade of neurovascular compression using fused 3D-TOF-MRA and 3D-FIESTA versus contrast-enhanced T1 weighted images. The Kappa test for interobserver agreement was done. Results: The final study cohort consisted of 56 patients (42 females and 14 males) with a mean age of 38.25 ± 1.94. AICA was the offending vessel for 32 (57.1%) patients. The most common offending nerve was the trigeminal nerve in 26 patients, followed by facial/vestibulocochlear complex in 18 patients, and solely the 8th nerve in 12 patients. All three grades of compression were encountered in this study with percentages of 48.2% (27/56), 30.3% (17/56), and 21.4% (12/56) for grades I, II, III respectively. Fused TOF and steady-state images, and contrast-enhanced images showed perfect agreement for detection of the side of compression, the relation between nerve and vascular loop, offended neural segment, and offending vessel, while showing good agreement regarding the degree of compression. Conclusion: Fused TOF and steady-state images provide sufficient data to diagnose and grade microvascular compression syndromes comparable to contrast-enhanced images.

Abstract Background and Aim: Lumbar posterior open microdiscectomy is a procedure that is widely used to treat lumbar disc diseases. These operations have a low risk of complications. It is unusual for the tool to break and remain in the intervertebral space during surgery. In this situation, we wanted to provide a set of suggestions based on our research of the literature on pituitary forceps blade fractures and the procedure for removing the fractured portion from the disc space during lumbar posterior open microdiscectomy surgery. Case Presentation: 10 days ago, a 37-year-old female patient presented to our clinic complaining of low back pain, left leg pain, and left foot weakness. A diagnosis of lumbar disc herniation necessitating surgery was obtained following neurological and radiographic examinations. The patient was advised to have surgery. The patient had standard lumbar microdiscectomy surgery. However, the tip of the pituitary forceps was broken during disc removal and remained in the L5-S1 disc space. The scope confirmed that the alien object was in space. After the evaluation, it was decided to remove the piece of instrument that was broken and remained in the disc space. The broken surgical handpiece was removed and documented under fluoroscopy. Additionally, it was forwarded to the technical unit for examination. Conclusion: A few case reports in the literature describe a surgical tool piece fracture that remained in the disc distance of the lumbar microdiscectomy. Complication management may be time-consuming and risky. Such a complication should be addressed and resolved appropriately because this situation might have detrimental terms on surgical risks and the legal procedure.

Abstract Introduction: Cranioencephalic trauma is a frequent reason for admission to emergency departments and is a source of mild to severe neuropsychological defects that will persist over time. Their management remains difficult. Objectives: To evaluate the sequelae presented by patients suffering from cranioencephalic trauma. Methods: This was a retrospective, descriptive, crosssectional study conducted at the National Hospital of Zinder. It will include all patients admitted and hospitalised in the emergency, intensive care and neurosurgery departments of Zinder National Hospital for head injury over a period of 28 months from 1 January 2016 to 30 April 2018. Brain scan, X-ray were the imaging tests used. Results: Out of a total of 974 admissions, 367 were retained, i.e. 37.6%, with a male predominance (82.6%). The average age was 26.5 years. MVAs were represented in 89.7% of cases. Moderate CTE accounted for 64% of cases. Altered consciousness was reported in 295 patients (80.38% of cases). Brain scans were used in 76.7% of cases and skull X-rays in 4.2% of cases. Medical management was performed in all patients. Treatment was operative in 78 patients (21.25%). Recovery without immediate sequelae was found in 187 patients (50.9%). Persistent headache represented 47.7% of the late sequelae observed in the patients, epileptic seizures represented 16.8% of the late sequelae, neurological deficit represented 14.7%. Conclusion: Cranioencephalic trauma represents a major public health issue. Although their in-hospital management remains a challenge, post-hospital management related to the appearance of sequelae remains another.