Spinal intramedullary schwannoma: Report of two cases with review of the literature.

INTRODUCTION: Spinal tumors comprise 15 % of all central nervous system tumors, with schwannomas accounting for 30 % of primary intraspinal neoplasms. While predominantly extramedullary-intradural, spinal schwannomas rarely manifest intramedullary occurrences (0.3 % of intraspinal tumors). This study sheds light on two rare cases of thoracic intramedullary schwannomas, emphasizing their diagnostic complexities and surgical management, alongside a literature review. CASE PRESENTATION: Case 1 involves a 50-year-old female presenting with worsening back pain, right lower limb weakness, and urinary incontinence. MRI revealed an intradural intramedullary soft tissue mass, diagnosed as a schwannoma with an associated organizing hematoma. Surgical removal led to gradual improvement. Case 2 features a 25-year-old male with back pain, partial foot drop, and weakness in the right knee and hip. MRI demonstrated an intradural intramedullary lesion, later confirmed as an intradural intramedullary schwannoma. Surgery resulted in a smooth recovery without adverse effects. DISCUSSION: This article presents two cases of intradural intramedullary thoracic schwannomas initially misdiagnosed as astrocytomas. Surgical resection confirmed the diagnosis, underscoring challenges in preoperative MRI diagnosis. The review of 174 reported cases reveals an equal distribution between the cervical and thoracic regions, with males affected 1.5 times more frequently than females. The average age of onset is 40, and surgical treatment demonstrates a 90 % improvement rate. The complex pathogenesis encompasses six proposed explanations. Clinical suspicion, considering pain and neurological symptoms, is paramount due to potential misdiagnosis and the imperative for histological confirmation. CONCLUSION: Although rare, intramedullary schwannomas (IMS) have significant clinical implications, necessitating precise treatment. Surgical resection yields favorable outcomes, with subtotal resection considered based on adhesion factors. Pre-surgical diagnosis requires a comprehensive integration of radiological and clinical data, with intraoperative analysis ensuring optimal treatment strategies.

Delayed brain abscess as a complication of cerebral infarction: A rare case report and review of the literature.

INTRODUCTION: Systemic infections are a common complication of cerebral stroke, while the development of a cerebral abscess on the background of infarcted brain tissue is an extremely rare occurrence. Here, we present a new case alongside a literature review. CASE PRESENTATION: A previously healthy 37-year-old man presented with sudden right-sided weakness and speech difficulties, progressing to complete aphasia. Initial tests showed no abnormalities, but subsequent CT scans revealed left basal ganglia infarction. Despite treatment and improvement, three months later, his condition worsened, leading to surgical intervention to excision of a cerebral abscess caused by Staphylococcus aureus. Following successful surgery and treatment, the patient showed improvement and was discharged for regular follow-up care. DISCUSSION: The convergence of stroke and brain abscess poses serious clinical challenges, requiring prompt diagnosis and treatment to mitigate catastrophic consequences. Brain abscess, stemming from cerebral infection, may arise from various sources, including contiguous spread, hematogenous dissemination, or traumatic injury. Diagnosis is complicated by nonspecific radiological findings, which often lead to misdiagnosis. Risk factors include age, immunocompromised states, and certain medical conditions. Despite challenges, early detection and appropriate management, involving surgical drainage and antimicrobial therapy, are crucial for favorable outcomes. CONCLUSION: Cerebral abscess following cerebral infarction is rare but should be suspected in patients with prior stroke or hemorrhage, experiencing worsening focal deficits and consciousness. Advanced age and comorbidities increase clinical suspicion.

Mobile schwannoma of the thoracolumbar spine: A case report.

INTRODUCTION: Schwannoma, a benign nerve sheath tumor originating from Schwann cells, can migrate within the spine due to various factors, impacting surgical planning. Unforeseen movement complicates treatment, and it is considered a very rare tumor. CASE PRESENTATION: A 24-year-old woman complained of persistent back pain and was examined at a neurosurgery clinic. Initial MRI found a spinal lesion that later moved, leading to two surgeries. The diagnosis was a Schwannoma, confirmed by examining the tissue under a microscope, showing characteristic features of a Schwannoma, specifically Antoni type A with recent hemorrhage. DISCUSSION: Schwannoma, a rare nerve cell tumor, often migrates within the spine due to its lack of attachment within the dura. The tumor's movement can be triggered by various factors like nerve root laxity, pressure changes, body positioning, or medical procedures. A case study discussed a woman with back pain; her tumor migrated between two MRI scans, showcasing a common migration pattern. Lower back pain commonly manifests as a primary symptom in most cases. Imaging techniques such as myelography and intraoperative ultrasound assist in locating and managing these mobile tumors, advocating for their utilization to minimize surgical complications. CONCLUSION: Reported a rare mobile thoracolumbar schwannoma from nerve sheath cells. Its mobility complicates surgery; precise imaging like intraoperative MRI and ultrasound are crucial for localization, preventing complications.

Pediatric ventriculoperitoneal shunt: a comparative study between anterior fontanel ultrasound-guided versus conventional cranial end insertion.

PURPOSE: Ventriculoperitoneal (V-P) shunt is one of the most common neurosurgical procedures in pediatrics for the treatment of hydrocephalus. Shunt failure is one of the common mechanical complications which lead to major morbidities. This study aims to compare between cranial part insertions of the V-P shunts guided by trans-anterior fontanel ultrasound versus conventional insertion. METHODS: A prospective comparative randomized study was conducted on 60 pediatric patients aged ≤ 2 years who suffered hydrocephalus and allocated into 2 groups. In the first group (n = 30), the cranial parts of the ventriculoperitoneal shunts were inserted guided by trans-anterior fontanel ultrasound, and in the second group (n = 30), the insertions were by the conventional method. The follow-up duration of the patients was 3 months. RESULTS: Proximal part obstruction of the V-P shunt was found in 3 cases of the conventional group during follow-up with statistical insignificance (p = 0.237) while adequate proximal part location recorded statistical significance (p = 0.0005) in favor of ultrasound-guided group. CONCLUSION: The use of the anterior fontanel ultrasound guide during ventriculoperitoneal shunt insertion is a feasible, safe, and effective technique for the placement of ventricular catheters in pediatric patients with a patent anterior fontanel.

Migration of Distal End of VP Shunt into the Scrotum: A Management Review.

Ventriculo-peritoneal (VP) shunt is the typical and most common procedure for the treatment of hydrocephalus. Many complications have been associated with VP shunts, migration of the distal end of the VP tube into the scrotum is a rare one. We report the presentation and management of a case of 3 month age infant who had scrotal swelling primarily diagnosed as hydrocele. Investigations proved the presence of shunt migration. The possibility of shunt migration should be considered. Early diagnosis and management of such complications is easy and can prevent subsequent serious sequelae.

Cerebral venous sinus thrombosis in COVID 19 patients: Report of 2 cases.

Background: Initially, novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) was considered primarily a respiratory pathogen. However, with time it has behaved as a virus with the potential to cause multi-system involvement, including neurological manifestations which varies from acute to subacute onset of headache, seizures, a decrease of consciousness, and paralysis. Case description: Two cases of cerebral sinus venous thrombosis in COVID-19 patients were reported, following respiratory disorders, which was triggered by the SARS-CoV-2 infection. The first patient, presented with a decrease in level of consciousness and hemiparesis, was 23 years old female having no history of previous medical co-morbidities. The latter case, 21 years old woman showed less severe presentations of COVID-19 associated with headache, vomiting and papilledema. These two cases marvellously improved with no neurological deficit with aggressive course of anticoagulation. Conclusion: CVST should be suspected in COVID-19 patients presenting with headache, paralysis, aphasia or seizures. The high mortality rate of CVST in COVID-19 infection warrants a high index of suspicion from physicians, and early treatment with anticoagulation should be initiated.

Flexural Behavior of a Novel Textile-Reinforced Polymer Concrete.

Textile reinforced concrete (TRC) has gained attention from the construction industry due to its light weight, high tensile strength, design flexibility, corrosion resistance, and remarkably long service life. Some structural applications that utilize TRC components include precast panels, structural repair, waterproofing elements, and façades. TRC is produced by incorporating textile fabrics into thin cementitious concrete panels. Premature debonding between the textile fabric and concrete due to improper cementitious matrix impregnation of the fibers was identified as a failure-governing mechanism. To overcome this performance limitation, in this study, a novel type of TRC is proposed by replacing the cement binder with a polymer resin to produce textile reinforced polymer concrete (TRPC). The new TRPC is created using a fine-graded aggregate, methyl methacrylate polymer resin, and basalt fiber textile fabric. Four different specimen configurations were manufactured by embedding 0, 1, 2, and 3 textile layers in concrete. Flexural performance was analyzed and compared with reference TRC specimens with similar compressive strength and reinforcement configurations. Furthermore, the crack pattern intensity was determined using an image processing technique to quantify the ductility of TRPC compared with conventional TRC. The new TRPC improved the moment capacity compared with TRC by 51%, 58%, 59%, and 158%, the deflection at peak load by 858%, 857%, 3264%, and 3803%, and the toughness by 1909%, 3844%, 2781%, and 4355% for 0, 1, 2, and 3 textile layers, respectively. TRPC showed significantly improved flexural capacity, superior ductility, and substantial plasticity compared with TRC.

Cerebral venous sinus thrombosis in patients with COVID-19 infection.

BACKGROUND: Despite the COVID-19 infection is more frequently related to acute respiratory distress but there is an increasing evidence of a heterogeneous spectrum of multi-system involvement including the central nervous system. Thromboembolic events after COVID-19 infection have been reported mainly in the pulmonary vasculature however; thromboembolic complications of the nervous system with subsequent cerebrovascular stroke have been increasingly reported. The most common cerebrovascular complication after COVID-19 infection is ischemic stroke however there is also reported cases of cerebral venous sinus thrombosis in such patients as well. In the current report we present two cases with extensive cerebral venous sinus thrombosis as a potential complication for COVID-19 infection. OBJECTIVE: Increase the awareness of neurological complications in patient with COVID-19 virus disease. METHODS: Reporting two cases with confirmed cerebral venous sinus obstruction in patient with confirmed COVID-19 infection. RESULTS: Two young adult males less than 30 years old have no other risk factors of hypercoagulable state apart from being COVID-19 infection victims complicated by CVST. Both of them had progressive course of deterioration in conscious level, right hemiplegia and only one seizures attack has been reported in (Case-1). Both patients in the current report died within one week of their initial symptoms in spite the aggressive medical and surgical treatment. CONCLUSION: CVST is a devastating complication when associated with COVID-19 infection and early investigations for cerebrovascular integrity by using MRA, MRV whenever there are unexplained neurological manifestations in patient with COVID-19 disease.

Pultruded GFRP Reinforcing Bars Using Nanomodified Vinyl Ester.

Glass fiber-reinforced polymer (GFRP) reinforcing bars have relatively low shear strength, which limits their possible use in civil infrastructure applications with high shear demand, such as concrete reinforcing dowels. We suggest that the horizontal shear strength of GFRP bars can be significantly improved by nanomodification of the vinyl ester resin prior to pultrusion. The optimal content of functionalized multiwalled carbon nanotubes (MWCNTs) well dispersed into the vinyl ester resin was determined using viscosity measurements and scanning electron micrographs. Longitudinal tension and short beam shear tests were conducted to determine the horizontal shear strength of the nanomodified GFRP reinforcing bars. While the tensile strength of the GFRP reinforcing bars was improved by 20%, the horizontal shear strength of the bars was improved by 111% compared with the shear strength of neat GFRP bars pultruded using the same settings. Of special interest is the absence of the typical broom failure observed in GFRP when MWCNTs were used. Differential scanning calorimetry measurements and fiber volume fraction confirmed the quality of the new pultruded GFRP bars. Fourier-transform infrared (FTIR) measurements demonstrated the formation of carboxyl stretching in nanomodified GFRP bars, indicating the formation of a new chemical bond. The new pultrusion process using nanomodified vinyl ester enables expanding the use of GFRP reinforcing bars in civil infrastructure applications.

Performance Evaluation and Kinetic Analysis of Photocatalytic Membrane Reactor in Wastewater Treatment.

The objectives of the current study are to assess and compare the performance of a developed photocatalytic membrane reactor (PMR) in treating industrial waste (e.g., organic dye waste) against membrane distillation. The current PMR is composed of a feed tank, which is a continuous stirred photocatalytic reactor containing slurry Titanium dioxide (TiO2) particles that are activated by using ultraviolet lamp irradiation at a wavelength of 365 nm, and a poly-vinylidene flouride (PVDF) membrane cell. The experimental setup was designed in a flexible way to enable both separate and integrated investigations of the photocatalytic reactor and the membrane, separately and simultaneously. The experimental work was divided into two phases. Firstly, the PVDF membrane was fabricated and characterized to examine its morphology, surface charge, and hydrophobicity by using a scanning electron microscope, surface zeta potential, and contact angle tests, respectively. Secondly, the effects of using different concentrations of the TiO2 photocatalyst and feed (e.g., dye concentration) were examined. It is found that the PMR can achieve almost 100% dye removal and pure permeate is obtained at certain conditions. Additionally, a kinetic analysis was performed and revealed that the photocatalytic degradation of dye follows a pseudo-first-order reaction.

Ossified Spinal Meningioma: A Case Report and a Review of the Literature.

Ossified spinal meningiomas are a rare form of spinal tumors. These tumors increase surgical morbidities due to their hard consistency and strong adhesion to the neural tissue and relatively narrow surgical space. Here, the authors describe the clinical findings, surgical strategies, and histological findings of a patient with an ossified meningioma. Preoperative diagnosis of these tumors can prevent surgical morbidities. Total resection can be curative with the application of meticulous microsurgical techniques.

Cranial migration of lumboperitoneal shunt: A case report and review of literature.

BACKGROUND: Lumboperitoneal shunt is an easy and effective way of managing benign intracranial hypertension (BIH) and other causes of increased intracranial pressure. Yet, it is associated with a relative high failure rate. Proximal migration of the shunt is rare and only few cases have been reported. CASE DESCRIPTION: Here, we present a case of a 16-year-old female, diagnosed with BIH, who had a proximal shunt migration 4 months after surgery and was managed conservatively, along with the review of literature. CONCLUSION: Although it is associated with a high complication rate, lumboperitoneal shunt is very effective in the management of many disorders. One of the most common complications is shunt migration. While many mechanisms explaining shunt migration have been hypothesized, the most important single preventing factor for preventing shunt migration remains proper fixation of the shunt.

Spontaneous cervical epidural hematoma: A case report and review of literature.

BACKGROUND: Spontaneous cervical epidural hematoma (SCEH) is an uncommon cause of acute spinal cord compression. This is a rare idiopathic condition that leads to acute onset of neurologic deficits, which if not diagnosed early can lead to catastrophic consequences. CASE DESCRIPTION: Here, we report a 41-year-old male, diagnosed with SCEH, with a presenting chief complaint of cervical pain followed by progressive quadriparesis and urgency of micturition who was managed surgically, along with the review of literature. CONCLUSION: SCEH is a rare pathologic entity. Due to the high risk of poor neurological outcome without treatment, SCEH should be a diagnostic possibility when the presentation is even slightly suggestive. Prompt surgical evacuation of the hematoma and hemostasis leads to a favorable neurological outcome, whereas delay in treatment can be disastrous.

Olfactory Nerve Schwannoma: A Case Report and Review of the Literature.

Schwannomas are benign tumors, which arise from the Schwann cells of the central or peripheral nerves. They form 8% of all intracranial tumors and most of the cases arise from vestibular division of the 8 th cranial nerve. Rare cases are shown to arise from the olfactory or optic nerve, being devoid of myelin sheath. Up to date and according to our best of knowledge, 66 cases have been reported till now. Here we present a review of the literature and a case report of a 56-year-old male with an accidently discovered anterior cranial fossa schwannoma, following a road traffic accident. Tumor was completely excised, using a right frontal approach. Histopathology revealed Antoni-A cellular pattern. Although rare, but olfactory nerve schwannomas should be included in the differential diagnosis in anterior cranial fossa space occupying lesions, and the approach should be designed taking into consideration, this rare entity.

Investigation of Pozzolanic Reaction in Nanosilica-Cement Blended Pastes Based on Solid-State Kinetic Models and 29Si MAS NMR.

The incorporation of pozzolanic materials in concrete has many beneficial effects to enhance the mechanical properties of concrete. The calcium silicate hydrates in cement matrix of concrete increase by pozzolanic reaction of silicates and calcium hydroxide. The fine pozzolanic particles fill spaces between clinker grains, thereby resulting in a denser cement matrix and interfacial transition zone between cement matrix and aggregates; this lowers the permeability and increases the compressive strength of concrete. In this study, Ordinary Portland Cement (OPC) was mixed with 1% and 3% nanosilica by weight to produce cement pastes with water to binder ratio (w/b) of 0.45. The specimens were cured for 7 days. 29Si nuclear magnetic resonance (NMR) experiments are conducted and conversion fraction of nanosilica is extracted. The results are compared with a solid-state kinetic model. It seems that pozzolanic reaction of nanosilica depends on the concentration of calcium hydroxide.

Extracting concrete thermal characteristics from temperature time history of RC column exposed to standard fire.

A numerical method to identify thermal conductivity from time history of one-dimensional temperature variations in thermal unsteady-state is proposed. The numerical method considers the change of specific heat and thermal conductivity with respect to temperature. Fire test of reinforced concrete (RC) columns was conducted using a standard fire to obtain time history of temperature variations in the column section. A thermal equilibrium model in unsteady-state condition was developed. The thermal conductivity of concrete was then determined by optimizing the numerical solution of the model to meet the observed time history of temperature variations. The determined thermal conductivity with respect to temperature was then verified against standard thermal conductivity measurements of concrete bricks. It is concluded that the proposed method can be used to conservatively estimate thermal conductivity of concrete for design purpose. Finally, the thermal radiation properties of concrete for the RC column were estimated from the thermal equilibrium at the surface of the column. The radiant heat transfer ratio of concrete representing absorptivity to emissivity ratio of concrete during fire was evaluated and is suggested as a concrete criterion that can be used in fire safety assessment.

Neurosurgical wound infection at a university hospital in Egypt; prospective study of 1,181 patients for 2 years.

AIM: The aim of this study is to report the incidence rate of neurosurgical wound infection at our university as well as the predisposing risk factors. MATERIAL AND METHODS: A 2-year hospital prospective study was conducted and included 1110 patients underwent 1181 elective neurosurgical procedures, 50.3% were male. The ages ranged between 4 days and 80 year with mean age of 33.9 ± 19.679. Instrumental spinal devices were applied in 189 (16%) of patients, and 114 (9.7%) underwent shunt surgery, while aneurysmal clips were used in 5 patients only. The mean duration of follow up was 17.46 ± 3.49 months. RESULTS: 41 patients suffered surgical wound infection representing 3.47 % of the patients. Staphylococcus aureus was the commonest organism in 10 (24.39%) patients followed by the E.coli in 5 (12.19%) patients, while the culture revealed no growth in 14 (34.14%) patients. 25 patients have one or more risk factors of wound infection. 28 cases were treated surgically and 13 patients received conservative treatment. 34 wound infections occurred early during hospitalization, while 7 patients had late wound infection. We have two death-related infection from meningitis and sever septicemia. CONCLUSION: The neurosurgical wound infection rate is usually low even in developing countries and remains within the accepted rate.

Laparoscopic revision of the distally obstructed ventriculoperitoneal shunt.

AIM: Evaluation of the laparoscopic assisted revision of the ventriculoperitoneal shunt as an alternative technique to the traditional laparotomy. MATERIAL AND METHODS: Out of 1181 elective neurosurgical procedures have been done from January 2009 to December 2010. There are 98 (8.2%) ventriculoperitoneal shunt procedures. New shunt insertion was performed 41 times (41.9%) and shunt revision performed 57 times (58.1%). Shunt-related infection was detected in 11 cases (11.22%) while mechanical failure was found in 46 cases (46.9%), proximal obstruction was diagnosed in 26 cases (26.5 %) while 20 patients (20.4%) suffered from distal obstruction. Out of the 20 patients with distal obstruction, 12 patients were treated with laparoscopic assisted revision of the peritoneal end. RESULTS: Intra operative finding revealed peritoneal adhesion in 83.3% of cases and cerebrospinal fluid pseudo cyst in 16.6% while extra peritoneal tube was found in one case. Intraoperative management included adhesiolysis in 10 patient, evacuation and marsupialization of the cyst in two cases in addition to tube repositioning in all cases. There was no procedure-related complications. CONCLUSION: Laparoscopic assisted revision of the peritoneal catheter is an alternative technique to traditional laparotomy in the revision of ventriculoperitoneal shunt.

Armored brain in patients with hydrocephalus after shunt surgery: review of the literatures.

Armored brain or chronic calcified subdural hematoma is a rare complication of cerebrospinal fluid diversion with few cases reported in the literature. Seventeen patients with this pathology have been published. A complete review of the literatures regarding this topic has been collected and discussed. The author also presents a 12- year old boy with triventricular hydrocephalus who had undergone ventriculoperitoneal medium pressure shunt system since birth. The patient presented to our clinic with a 2-year history of seizures. The patient was conscious and without neurological deficits on examination. Computed tomography of the brain showed bilateral high density mass with surface calcification. X ray skull and MRI confirmed the calcified subdural hematoma bilaterally. We preferred conservative treatment and the patient continued his antiepileptic treatment. At one year follow up, the patient had the same neurological state. The case highlights the importance of frequent follow up CT brain after shunt surgery.

Opening wedge trapezial osteotomy as possible treatment for early trapeziometacarpal osteoarthritis: a biomechanical investigation of radial subluxation, contact area, and contact pressure.

PURPOSE: Radial subluxation and cartilage thinning have been associated with initiation and accelerated development of osteoarthritis of the trapeziometacarpal joint. Few investigators have reported on the benefits of opening wedge trapezial osteotomy for altering the contact mechanics of the trapeziometacarpal joint as a possible deterrent to the initiation or progression of osteoarthritis. We used cadaveric specimens to determine whether opening wedge osteotomy of the trapezium was successful in reducing radial subluxation of the metacarpal base and to quantify the contact area and pressure on the trapezial surface during simulated lateral pinch. METHODS: We used 8 fresh-frozen specimens in this study. The flexor pollicis longus, abductor pollicis longus, adductor pollicis, abductor pollicis brevis, and flexor pollicis brevis/opponens pollicis tendons were each loaded to simulate the thumb in lateral pinch position. We measured radial subluxation from anteroposterior radiographs before and after placement of a 15° wedge. We used real-time sensors to analyze contact pressure and contact area distribution on the trapezium. RESULTS: Center of force in the normal joint under lateral pinch loading was primarily located in the dorsal region of the trapezium. After wedge placement, contact pressure increased in the ulnar-dorsal region by 76%. Mean contact area increased in the ulnar-dorsal region from 0.05 to 0.07 cm(2), and in the ulnar-volar region from 0.003 to 0.024 cm(2). The average reduction in joint subluxation was 64%. CONCLUSIONS: The 15° opening wedge osteotomy of the trapezium reduced radial subluxation of the metacarpal on the trapezium and increased contact pressure and contact area away from the diseased compartments of the trapezial surface. Trapezial osteotomy addresses the 2 preeminent theories about the initiation and progression of osteoarthritis. CLINICAL RELEVANCE: By reducing radial subluxation and altering contact pressure and contact area, trapezial osteotomy may prove an alternative to first metacarpal extension osteotomy or ligament reconstruction in early stages of degenerative arthritis of the trapeziometacarpal joint.