Surprising outcome of ommaya reservoir in treating cystic craniopharyngioma: a retrospective study.

BACKGROUND: Surgical removal (gross total or partial removal), radiotherapy and cyst evacuation have all been used individually or in combination to treat cystic craniopharyngioma, although it is unclear which is the best method. OBJECTIVE: To report the results of treating cystic craniopharyngioma by insertion of an Ommaya reservoir system (ORS) and aspiration of the cyst. PATIENTS AND METHODS: As from 1990, patients admitted to the neurosurgical department at Assiut University Hospital, Egypt, with grossly cystic craniopharyngioma and who had a single cyst and did not have previous surgery were treated by insertion of an ORS and drainage of the cyst. By 2010, 52 patients had received this treatment with the cystic fluid aspirated completely on the day of surgery. The main presenting symptoms were raised intracranial pressure and visual changes with hormonal changes observed in some patients. The minimal follow-up period was 7 years. RESULTS: To our surprise, 38 (73%) patients did not develop any recollection of the cyst and showed significant clinical improvement. The only possible explanation is that the part of the catheter of the ORS, with holes in, has established communication between the cyst and the CSF spaces around it after the collapse of the cyst with no adverse effect on the patient at any time. Ten (19%) patients needed reaspiration every 6 months and four (8%) patients showed rapid recollection of cystic fluid and were treated with intracystic bleomycin. CONCLUSION: Treatment of cystic craniopharyngioma by drainage through an ORS is very effective. The majority of patients do not need any further treatment. Those who develop re-accumulation of cystic fluid are easily treated by simple aspiration of the fluid through the reservoir. It is a simple and safe method, which lacks the risks associated with surgery or chemotherapy.

Pre- and postoperative changes in serum myelin basic protein immunoreactivity in neurosurgical patients.

In 44 patients undergoing neurosurgical procedures for intracranial tumors, subarachnoid hemorrhage, or spinal and peripheral nerve lesions, serum myelin basic protein (MBP) immunoreactivity was measured preoperatively and serially in the first 10 postoperative days. The double-antibody radioimmunoassay method was used, with a detection limit of 2.5 ng/ml in serum. Clinical evaluation was carried out at admission and on successive days during the period of neurosurgical management; outcome was assessed later. In the early postoperative phase, there was a fall in MBP immunoreactivity in all groups of patients. In the groups with intracranial tumor and subarachnoid hemorrhage, there was a subsequent rise in MBP immunoreactivity before the end of the 10-day period, which was not found in the group with spinal and peripheral nerve lesions.

Computed tomography and mortality rate in brain abscess.

A small series of eleven consecutive cases of brain abscess, with one death, is presented. Early diagnosis and accurate localisation by computed tomography (ct) are emphasized and the clinical features discussed.

Subdural haematoma and the malfunctioning shunt.

Of 30 consecutive children with hydrocephalus treated by shunt implant, six developed subdural haematoma. Four of them presented with a malfunctioning shunt, and the diagnoses in all six cases were made by CT scan.

The impact of computed tomography on the treatment of chronic subdural haematoma.

Twenty four consecutive patients with chronic subdural haematoma were treated by burr hole evacuation. Pre-operative and post-operative CT scans were performed and all patients developed a re-collection of fluid within the first week. This did not adversely influence clinical improvement and resolved spontaneously.

The results of anterior cervical fusion in cervical spondylosis. Review of 125 cases.

A retrospective study of 125 patients with cervical spondylosis with, in the main, myelographic features, and treated by the anterior cervical route (Cloward's operation) is presented. Patients were selected for this type of surgery as opposed to the posterior approach, on clinical and radiological grounds which are described. Results of this treatment have generally been good and this is particularly so in very elderly patients with a single lesion at C 3/4. There is a group of patients in whom the disease process seems to progress despite surgery.

Preliminary report on some clinical and biochemical observations in patients treated with Bilharcid.

Tartar emetic (potassium antimony tartrate) has been used since a long time as the drug of choice for the treatment of Bilharziasis in Egypt. This drug, though effective, has severe side effects. A newly synthesized trivalent antimony preparation (piperazine di-antimonyl tratrate) Bilharcid, has proved in animal experiments to be less toxic, more effective, and having little side effects. The drug was tried in various schemes on various age groups of patients infected with S. haematobium. Control cases were treated with tartar emetic. Urine analysis was done for the detection of living or dead ova before and after treatment. E.C.G., alkaline phosphatase, serum transaminase, lactic dehydrogenase, and urea tests were done before and after treatment. Follow up studies were recorded for three months after treatment. Results are presented in the full text.