Effect of quadriceps and calf muscles fatigue on standing balance in healthy young adult males.

OBJECTIVE: The present study aimed to compare the effects of quadriceps or calf muscles fatigue on static and dynamic standing balance in young healthy adult males. METHODS: Forty-five healthy, physically active male adults aged 18-30 years were randomly divided into three groups; Quadriceps muscle fatigue group (n=15), Calf muscles fatigue group (n=15), and a control group (n=15). The Modified Clinical Test of Sensory Interaction on Balance, Unilateral Stance, and Limits of Stability (reaction time and movement velocity) were selected as outcome measures for this study. RESULTS: The results showed a non-significant difference between pretest and posttest balance scores (p>0.05) for quadriceps and calf muscles fatigue on balance. Similarly, there were non-significant differences in posttest balance scores when comparing fatigue effects between the groups (p>0.05). CONCLUSIONS: These results suggested that the fatigue of the quadriceps or calf muscles did not influence standing balance in healthy young adult males. Future longitudinal studies are recommended to further understanding the mechanisms behind localized muscle fatigue effects on standing balance in subjects of different age groups of both genders.

Tumors of the lateral and third ventricle: surgical management and outcome analysis in 42 cases.

OBJECTIVE: To discuss the clinical presentation, pathological diagnosis, and surgical outcome for a series of 42 consecutive patients treated for lateral and third ventricular tumors. METHODS: This is a retrospective series study conducted between 2001 and 2015 and included 42 patients (mean age: 25 years; range: 2 months-65 years) with lateral and third ventricle tumors surgically treated at King Khaled University Hospital, Riyadh, Kingdom of Saudi Arabia. Demographic, clinical, radiological, surgical, histopathological, and follow up data were analyzed. RESULTS: The most common symptoms at presentation included headache (69%), nausea/vomiting (38%), visual deficits (24%), and seizures (17%). Lesions were located in the lateral ventricle in 15 patients, third ventricle in 20 patients, and involved both the lateral and third ventricles in 7 patients. The most common tumor types in the overall cohort were colloid cysts (n=6) and pineal tumors (n=6). The postoperative complication rate was 36%. The most common postoperative complications were seizure and hydrocephalus (n=5 each, 12%). Surgical mortality was 5%. CONCLUSION: The selection of the surgical approach for intraventricular tumor resection is fundamentally dependent on the surgeon`s experience and preference. We recommend that this decision be based on the anatomic considerations that provide the best and safest access to the mass, rather than on the risk of seizure following transcortical approach.

Atypical Presentation of Idiopathic Intracranial Hypertension: A Case Series and Literature Review.

Idiopathic intracranial hypertension (IIH) is a condition in which intracranial pressure (ICP) increases without an apparent cause. Typically, patients present with headaches, dizziness, pulsatile tinnitus, visual disturbances, blurred vision, diplopia, photophobia, visual field defects, and papilledema on fundoscopy. The association between IIH, spontaneous cerebrospinal fluid (CSF) rhinorrhea, and arachnoid cysts has been discussed in the literature; however, there is no clear explanation for this association. We aimed to present a series of four patients with a confirmed diagnosis of IIH with atypical presentations, discuss the management of each case, and provide an explanation for this association to alert clinicians to the atypical presentation of IIH and facilitate early diagnosis and proper treatment of this condition by CSF diversion. This was a retrospective case series of all patients who were diagnosed with IIH and showed improvement after ventriculoperitoneal shunt insertion after failure of at least one operative intervention resulting from primary radiological and clinical findings in 2001 to 2022. Data on demographics, clinical presentation, radiological findings, surgical management, and diagnostic criteria for IIH were recorded. We identified four patients with a confirmed diagnosis of IIH who presented with atypical presentations as follows: intracranial arachnoid cyst, cervical spine arachnoid cyst, giant Virchow perivascular space, and spontaneous CSF (CSF) rhinorrhea. All patients responded to CSF diversion after failure of surgical treatment targeting the primary pathology. IIH should be suspected after the failure of primary surgical treatment in cases of spontaneous CSF rhinorrhea, spinal and cranial arachnoid cysts, and symptomatic ventriculoperitoneal shunt. Treatment in such situations should be directed toward IIH with CSF diversion.

Outcome of Childhood Cerebellar Pilocytic Astrocytoma: A Series With 20 Years of Follow Up.

BACKGROUND: Cerebellar pilocytic astrocytoma (PCA) is one of the few CNS tumors that can be cured with gross-total removal (GTR). In this series, we had 39 patients diagnosed with cerebellar PCA, 27 patients (70%) had GTR, and mean follow-up period was 62 months with no tumor recurrence. OBJECTIVE: To assess the long-term outcome of childhood cerebellar PCA treated at our institute during the period 2000-2020 and to highlight our surgical protocol. METHODOLOGY: Retrospective review of all patients under 18 years of age who were diagnosed with cerebellar PCA and had surgical excision between 2000 and 2020 at the Medical City of King Saud University. RESULTS: The study included 39 patients: 17 males and 22 females, the mean age was 8.4 years. Radiologically, the tumor was solid in eight patients, cystic in 15 patients, and mixed components were found in 16 patients. The lesion was located in the right cerebellar hemisphere in 12 patients, left cerebellar hemisphere in five patients, and midline 22 patients. The tumor size ranged from 2 to 7 cm in its greatest diameter, it was <5 cm in 13 patients and >5 cm in 26 patients. Thirty-one patients had preoperative hydrocephalus. GTR of the tumor was achieved in 27 patients and subtotal resection (STR) was done in 12 patients, 18 patients required permanent ventriculoperitoneal (V-P) shunt, and five patients had postoperative radiotherapy. Postoperative complications included infection in two patients, cerebellar mutism in two patients, and significant neurologic disability in four patients. The duration of follow-up ranged from 0 to 240 months (mean follow-up period: 62.0 months). The outcome at 10 years was good in 30 patients, fair in four patients, poor in four patients, and one patient died. Recurrence was documented in nine patients, seven of them had GTR and two had STR. CONCLUSION: GTR, if achievable, is curative for childhood cerebellar PCA. Many posterior fossa surgical complications could be avoided with watertight dural closure. Although new dural substitutes are available we prefer using autologous grafts (pericranium). It is easy to harvest pericranial graft from the external ventricular drain (EVD) site. The insertion of EVD synchronously with GTR of the tumor and gradual weaning of EVD could avoid the insertion of V-P shunt.

Ventriculo-sagittal sinus shunt malfunction. Causes of failure, avoidance, and alternatives.

This case report highlights causes of failure of the ventriculo-sagittal sinus (V-S) shunt and precautions to avoid them. We present, a 14-year-old girl, a case of post-hemorrhagic hydrocephalus with multiple revisions of ventriculo-peritoneal (V-P) and ventriculo-atrial (V-A) shunts. She developed malfunctioned V-S shunt, and ventriculitis that was complicated with massive cerebellar and brain stem infarction and the patient died. To avoid malfunction, a cardiac catheter with side slits should be used, magnetic resonance angiography is recommended before shunt placement to check the patency of the sinus, and the pressure in the superior sagittal sinus should be measured at the time of surgery. In patients with problematic distal catheters, direct placement of the catheter into the right atrium using thoracoscope could be an alternative to gall bladder or ureter shunts.

The effect of prone position on respiratory mechanics during spinal surgery.

OBJECTIVE: To study the effect of prone position on respiratory mechanics during spine surgery. DESIGN: Prospective study. SETTING: Elective spine surgery at a university hospital. PATIENTS: 12 ASA physical I & II with no coexisting cardiorespiratory disease undergoing cervical or lumbar laminectomy under general anesthesia in prone position. MEASUREMENTS: Ten min after induction of general anesthesia and endotracheal intubation, while patients were in supine position, the following measurements were taken using anesthesia delivery unit (Datex Ohmeda type A_Elec, Promma, Sweden): peak airway pressure (Ppeak), peak plataeu pressure (Pplat), peak mean pressure (Pmean) and dynamic lung compliance (DLC). The same measurements were recorded 10 min after placing patients into prone position. At the end of surgery and 5 min after turning the patients supine and before tracheal extubation, the same measurements were again recorded. The results expressed as means +/- sd. One way ANOVA was used for analysis of differences in the data before, during prone position and after turning patients supine at the end of the procedure. For all comparisons p < 0.05 was considered significant. RESULTS: During prone position there was significant reduction in DLC and significant increase in airway pressures. CONCLUSION: We conclude that turning the patients form supine to prone position during anesthesia for spine surgery caused significant decrease of DLC and significant increase of airway pressure.

Craniopharyngioma. Analysis of factors that affect the outcome.

OBJECTIVE: The aim of this work is to find out factors that affect the outcome of treatment of patients with craniopharyngioma treated at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. METHODS: This study was carried out retrospectively by reviewing the medical records of all patients with craniopharyngiomas treated at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia in the last 10 years (January 1990 through to December 1999), and collecting clinical, radiological, surgical, and follow-up data and performing statistical analysis to find out factors that affect the outcome of such cases. RESULTS: There were 11 females (61%), and 7 males (39%), the median age was 24 years. The main presenting symptoms were reduced vision in 66.7%, symptoms of raised intracranial pressure in 50%, endocrinal problems in 33.3%, seizures in 16.7%, and hemiparesis in 5.6%. Radiologic studies showed 72% of tumors had mixed solid and cystic components, calcification in 83%, and ventricular dilatation in 50% of cases. The tumor extended to the posterior fossa in 11%, and to both middle and posterior fossae in 11% of cases. Eighty-nine percent of patients had tumor excision through pterional craniotomy and 11% through subfrontal approach. Gross total removal was achieved in 17% and subtotal resection in 83%. Tumor recurred in 9 patients (50%), 4 of them (44%) had postoperative radiotherapy. The outcome was good in 10 patients (56%), poor in 6 patients (33%), and 2 patients died (11%). The patient age, radiological appearance of tumors and their location were significantly correlated with the outcome (p 0.02, 0.02, 0.04). CONCLUSION: Ophthalmologists and Pediatricians should be aware of the clinical presentation and refer patients to specialized centers for treatment. Total resection of the tumor should be the goal of the Neurosurgeon as it offers the best chance of cure.

Adult craniopharyngioma. Clinical, radiological presentation and outcome of management.

OBJECTIVE: The objective of this study was to ascertain the patterns of clinical and radiological presentation and the outcome of management of adult patients with craniopharyngioma (CRF). METHODS: A retrospective review of adult patients (>\= 18 years) with CRF treated at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia during the period January 1990 to December 2001. Fifteen children with CRF were excluded from the study. RESULTS: There were 11 patients, 6 females (54.5%), and 5 males (45.5%); the mean age was 33.7 years (median 31). The main presenting symptoms were reduced vision in 82%, symptoms of raised intracranial pressure (ICP) in 36.4%, endocrinal problems in 36.4%, seizures in 9%, and hemiparesis in 9%. Radiological studies showed 72.7% of tumors had mixed solid and cystic components, calcification in all tumors, and ventricular dilatation in 3 patients, with 2 of them (18.2%) having ventriculo-peritoneal shunt. Eighty-two percent of patients had tumor excision through pterional craniotomy and 18% through subfrontal approach. Gross total removal was achieved in 3 patients (27.3%), and subtotal resection in 72.7%. Tumor recurred in 4 patients (36.4%). The outcome was good in 8 patients (72.7%); poor in one patient (9%), and 2 patients died (18%). CONCLUSION: Adult patients with CRF had better surgical outcome than children, therefore, total resection of the tumor should be the goal of treatment as it offers the best chance of cure; however, it should not be at the expense of severe functional disability.

Craniopharyngioma: Analysis of factors that affect the outcome.

OBJECTIVE: The aim of this work is to find out factors that affect the outcome of treatment of patients with craniopharyngioma treated at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. METHODS: This study was carried out retrospectively by reviewing the medical records of all patients with craniopharyngiomas treated at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia in the last 10 years (January 1990 through to December 1999), and collecting clinical, radiological, surgical, and follow-up data and performing statistical analysis to find out factors that affect the outcome of such cases. RESULTS: There were 11 females (61%), and 7 males (39%), the median age was 24 years. The main presenting symptoms were reduced vision in 66.7%, symptoms of raised intracranial pressure in 50%, endocrinal problems in 33.3%, seizures in 16.7%, and hemiparesis in 5.6%. Radiologic studies showed 72% of tumors had mixed solid and cystic components, calcification in 83%, and ventricular dilatation in 50% of cases. The tumor extended to the posterior fossa in 11%, and to both middle and posterior fossae in 11% of cases. Eighty-nine percent of patients had tumor excision through pterional craniotomy and 11% through subfrontal approach. Gross total removal was achieved in 17% and subtotal resection in 83%. Tumor recurred in 9 patients (50%), 4 of them (44%) had postoperative radiotherapy. The outcome was good in 10 patients (56%), poor in 6 patients (33%), and 2 patients died (11%). The patient age, radiological appearance of tumors and their location were significantly correlated with the outcome (p 0.02, 0.02, 0.04). CONCLUSION: Craniopharyngiomas are a common tumor in children. Ophthalmologists and Pediatricians should be aware of the clinical presentation and refer patients to specialized centers for treatment. Total resection of the tumor should be the goal of the Neurosurgeon as it offers the best chance of cure.

Split cord malformation associated with spinal open neural tube defect.

OBJECTIVE: To illustrate the clinical and radiological findings of split cord malformation (SCM) in patients with spinal open neural tube defect (SONTD), and report the outcome of their treatment. METHODS: A retrospective study of the clinical and radiological findings of 11 patients diagnosed with SCM, identified among 83 patients with SONTD at King Khalid University Hospital, in Riyadh, Saudi Arabia between 1995 and 2010. RESULTS: There were 6 girls and 5 boys; their age ranged from less than a year to 9 years (mean 4.2 years). Six patients had type I SCM, and 5 patients type II SCM. The CT and MRI imaging showed characteristic bony, cartilaginous, or fibrous septum, and other SONTD-associated anomalies. Seven patients were graded A & B according to the Frankel grading score, and none of them required surgery, while worsening neurology led to surgical intervention in 3 patients, with clinical improvement after surgery, and one patient that underwent cord untethering remained stable. CONCLUSION: Split cord malformation is not uncommon among patients with SONTD. It tends to involve mainly the lumbar spine, and female predominance is more remarkable in type I. Neurological manifestations of SCM may be superimposed with SONTD. Surgery is effective for symptomatic patients, and not indicated in the severely disabled.

Agenesis of the corpus callosum associated with spinal open neural tube defect.

OBJECTIVE: To ascertain the incidence and clinical implications of agenesis of the corpus callosum (ACC) in spinal open neural tube defects (SONTD). METHODS: All cases of SONTD registered at the Spina Bifida Clinic in King Khalid University Hospital, Riyadh, Saudi Arabia between 1995 and 2010 were retrospectively reviewed, and mid-sagittal MRI of the corpus callosum (CC) area was analyzed in each case. Neurodevelopmental outcome was classified as poor in children with seizures, severe neurodevelopmental impairment, or death. RESULTS: Thirty-eight patients (45.8%) with ACC were identified among 83 cases with SONTD. Patients' age ranged between one and 16 years. Total ACC was found in 10 patients, partial ACC in 25, and in 3 patients, the CC was hypoplastic. Active hydrocephalus was an associated finding in 9 out of 10 patients with total ACC, 22 out of 25 with partial ACC, and in all patients with hypoplasia of the CC. Thirteen patients (34.2%) had normal intellectual function, whereas 24 patients presented with learning disability, epilepsy, or poor intellectual function; and one patient died of respiratory failure. CONCLUSION: Agenesis of the corpus callosum is found in a significant portion of patients with SONTD. When associated with hydrocephalus, its presence affects neuro-developmental outcome.