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Aly MM, Soliman Y, Elemam RA, Pizones J, Alzahrani A, Elwatidy S. How frequently MRI modifies thoracolumbar fractures' classification or decision-making? A systematic review and meta-analysis. Eur Spine J 2024; 33:1540-1549. [PMID: 38342842 DOI: 10.1007/s00586-023-08087-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 07/31/2023] [Accepted: 12/05/2023] [Indexed: 02/13/2024]
Abstract
PURPOSE To provide the first meta-analysis of the impact of magnetic resonance imaging (MRI) on thoracolumbar fractures (TLFs) classification and decision-making. METHODS A systematic review was conducted following PRISMA guidelines. We searched PubMed, Scopus, Cochrane, and Web of Science from inception to June 30, 2023 for studies evaluating the change in TLFs classification and treatment decisions after MRI. The studies extracted key findings, objectives, and patient population. A meta-analysis was performed for the pooled frequency of change in AO fracture classification or treatment decisions from surgical to conservative or vice versa after MRI. RESULTS This meta-analysis included four studies comprising 554 patients. The pooled frequency of change in TLFs classification was 17% (95% CI 9-31%), and treatment decision was 22% (95% CI 11-40%). An upgrade from type A to type B was reported in 15.7% (95% CI 7.2-30.6%), and downgrading type B to type A in 1.2% (95% CI 0.17-8.3%). A change from conservative to surgery recommendation of 17% (95% CI 5.0-43%) was higher than a change from surgery to conservative 2% (95% CI 1-34%). CONCLUSIONS MRI can significantly change the thoracolumbar classification and decision-making, primarily due to upgrading type A to type B fractures and changing from conservative to surgery, respectively. These findings suggest that MRI could change decision-making sufficiently to justify its use for TLFs. Type A subtypes, indeterminate PLC status, and spine regions might help to predict a change in TLFs' classification. However, more studies are needed to confirm the association of these variables with changes in treatment decisions to set the indications of MRI in neurologically intact patients with TLFs. An interactive version of our analysis can be accessed from here: https://databoard.shinyapps.io/mri_spine/ .
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Affiliation(s)
- Mohamed M Aly
- Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, P.O Box 54146, 11514, Riyadh, Saudi Arabia.
- Department of Neurosurgery, Mansoura University, Mansoura, Egypt.
| | | | | | - Javier Pizones
- Unidad de Columna, Hospital Universitario La Paz, Madrid, Spain
| | - Ahmed Alzahrani
- Department of Neurosurgery, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Sherif Elwatidy
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Ajlan A, Basindwah S, Hawsawi A, Alsabbagh B, Alwadee R, Abdulqader SB, Alzhrani G, Orz Y, Bafaqeeh M, Alobaid A, Alyamany M, Farrash F, Alaskar A, Alkhathlan M, Alqurashi A, Elwatidy S. A Prospective Comparison Between Soft Tissue Dissection Techniques in Pterional Craniotomy: Functional, Radiological, and Aesthetic Outcomes. Oper Neurosurg (Hagerstown) 2024; 26:256-267. [PMID: 37815213 DOI: 10.1227/ons.0000000000000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/04/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Given the complex anatomy of the operative region and individual surgeon preferences, some techniques for soft tissue dissection before pterional craniotomy have gained more popularity than others. This prospective study used subjective and objective measurements to compare the functional, radiological, and aesthetic outcomes of 3 such dissection techniques. METHODS This multicenter prospective cohort study included all patients who underwent elective pterional craniotomy between 2018 and 2020 at 3 centers in Riyadh, Saudi Arabia. All patients underwent 1 of 3 soft tissue dissection techniques: myocutaneous flap, interfascial, and subfascial dissection techniques. Clinical and radiological assessments were performed upon discharge and at the 3- and 6-month follow-ups. RESULTS We included 78 patients, with a mean age of 44.9 ± 16.3 years. Myocutaneous flap, interfascial, and subfascial dissections were performed in 34 (43%), 24 (30%), and 20 patients (25%), respectively. The myocutaneous flap method had the shortest opening ( P = .001) and closure ( P = .005) times; tenderness was more evident in this group than in the others ( P = .05). The frontalis muscle was most affected in the interfascial dissection group ( P = .05). The frontalis nerve function was similar in all groups after 6 months ( P = .54). The incidence of temporomandibular joint dysfunction was highest in the myocutaneous flap group (29%). Decreased temporalis muscle thickness at the 6-month postoperative follow-up was most severe in the subfascial dissection group (12.6%), followed by the myocutaneous flap (11.9%) and interfascial dissection (9.9%) groups, with no significant difference ( P = .85). Temporal hollowing was more prominent in the myocutaneous flap group ( P = .03). Cosmetic satisfaction was highest in the interfascial dissection group, with no significant difference ( P = .4). CONCLUSION This study provides important information for neurosurgeons in weighing the benefits and risks of each technique for their patients.
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Affiliation(s)
- Abdulrazag Ajlan
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh , Saudi Arabia
| | - Sarah Basindwah
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh , Saudi Arabia
| | - Aysha Hawsawi
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh , Saudi Arabia
| | - Badriah Alsabbagh
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh , Saudi Arabia
| | - Rawan Alwadee
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh , Saudi Arabia
| | | | - Gmaan Alzhrani
- Department of Neurosurgery, King Fahad Medical City, Riyadh , Saudi Arabia
| | - Yasser Orz
- Department of Neurosurgery, King Fahad Medical City, Riyadh , Saudi Arabia
| | - Mohammed Bafaqeeh
- Department of Neurosurgery, King Fahad Medical City, Riyadh , Saudi Arabia
| | - Abdullah Alobaid
- Department of Neurosurgery, King Fahad Medical City, Riyadh , Saudi Arabia
| | - Mahmoud Alyamany
- Department of Neurosurgery, King Fahad Medical City, Riyadh , Saudi Arabia
| | - Faisal Farrash
- Division of Neurosurgery, Department of Neuroscience, King Faisal Hospital and Research Center, Riyadh , Saudi Arabia
| | - Abdulaziz Alaskar
- College of Medicine, Prince Sattam Bin Abdulaziz University, Riyadh , Saudi Arabia
| | - Malak Alkhathlan
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh , Saudi Arabia
| | - Ashwag Alqurashi
- Division of Neurosurgery, Department of Surgery, King Saud University Medical City, Riyadh , Saudi Arabia
| | - Sherif Elwatidy
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh , Saudi Arabia
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3
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Alanazi AI, Alanezi T, Aljofan ZF, Alarabi A, Elwatidy S. Lhermitte-Duclos disease: A systematic review. Surg Neurol Int 2023; 14:351. [PMID: 37810307 PMCID: PMC10559389 DOI: 10.25259/sni_555_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/02/2023] [Indexed: 10/10/2023] Open
Abstract
Background Lhermitte-Duclos disease (LDD) is a rare tumor, with only about 300 reported cases. It often shows comorbidity with Cowden syndrome (CS); however, it can occur by itself. Radiologically, the "tiger-stripe" appearance is considered pathognomonic. Surgical resection remains the mainstay of treatment. This report aims to describe the clinical and radiological characteristics of LDD and its relationship with CS according to age group. Methods PubMed electronic databases were searched in August 2022. The search terms included "Lhermitte- Duclos disease" and "dysplastic gangliocytoma," which yielded 297 and 103 research articles, respectively. The articles were collected and reviewed by three researchers. Results Out of 400 identified articles, we analyzed 302 reported cases. The mean age at presentation was 33.6 ± 16 years; 171 patients (56.6%) were female, and 123 (40.7%) were male. The most commonly reported symptom was headache (174 patients, 57.6%), followed by ataxia (109, 36.1%). In addition, 99 cases (32.8%) were associated with CS, and 60 (19.9%) had a confirmed phosphatase and tensin homolog (PTEN) mutation. A tiger-stripe appearance was observed in 208 cases (58.7%); surgical resection was performed in 64.2% of the cases. Mortality and recurrence rates were 4.3% and 8.6%, respectively. No statistically significant difference was found between adult- and pediatric-onset LDD for the association with CS (P = 0.128). Conclusion Our findings suggest that adult and pediatric LDD have major commonalities; however, further prospective studies are warranted.
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Affiliation(s)
- Aued Iaed Alanazi
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Tariq Alanezi
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ziyad Fahad Aljofan
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alwaleed Alarabi
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sherif Elwatidy
- Department of Neurosurgery, King Saud University, Riyadh, Saudi Arabia
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Elwatidy S, Alanazi A, Alanazi RF, Alraddadi KK. Intraosseous meningioma, a rare presentation of a common brain tumor: illustrative case. J Neurosurg Case Lessons 2022; 4:CASE22331. [PMID: 36461833 PMCID: PMC9552680 DOI: 10.3171/case22331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/01/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The subset of extradural meningiomas arising from bone is called primary intraosseous meningioma. The present article outlines the clinical presentation, investigation, surgical management, and clinical outcomes of a challenging case of intraosseous meningioma. OBSERVATIONS A 27-year-old male presented with new-onset seizure of 3 years' duration and growing painless hard swelling involving the left frontoparietal bone, the medial aspect of the left orbit, the nasal bone, and the temporal bone. Brain computed tomography showed a diffuse intradiploic space osseous lesion with a ground-glass appearance. The patient underwent bifrontal craniotomy and tumor excision. The histopathological sections showed the presence of classic whorls of meningothelial cells around reactive bony tissue suggestive of intraosseous meningioma. Postoperatively, the patient was neurologically intact, and he was discharged in a stable condition. The outcome of this case was satisfactory. LESSONS The treatment of primary intraosseous meningioma is wide surgical excision together with the involved dura and any intradural tumor. The location of the tumor determines the approach and the amount of resection, keeping in mind preservation of function. The use of adjuvant therapy is reserved for cases of tumor recurrence or an atypical type.
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Affiliation(s)
- Sherif Elwatidy
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Rahaf F. Alanazi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; and
| | - Khulood K. Alraddadi
- Adult Neurosurgery Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
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Babiker A, Alaqeel B, Al-Eyadhy A, Selayem NA, Alissa S, Alsofyani A, Masuadi E, Al Juraibah F, Elwatidy S, Maghnie M. Postoperative intensive care management and residual endocrinopathy of pediatric supratentorial brain tumors: a retrospective cohort study. J Pediatr Endocrinol Metab 2022; 35:795-802. [PMID: 35585761 DOI: 10.1515/jpem-2021-0779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/05/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Endocrinopathy can occur as a postoperative sequel in children treated for supratentorial tumors (STTs). We assessed prediction of a residual hypothalamic/pituitary insufficiency (HPI) in these patients and factors associated with prolonged length of hospital stay (LOS). METHODS This is a retrospective cohort study of children who had surgery for STTs in two tertiary centers in Saudi Arabia (2009-2019). We assessed PICU postoperative management and risk of HPI. Data were analyzed using SPSS V24.0 and a logistic regression model for a prediction of a prolonged LOS. RESULTS Data included 55 children (1-18 years, mean 9.5 ± 4.9 years) who required STT surgeries, 32 (54%) females. Craniopharyngioma (27.3%) was the commonest STTs and 20% of patients had initial symptoms of HPI. PICU management included the use of different types of intravenous fluids (IVFs) and medications such as steroids and desmopressin (DDAVP). An early postoperative DI was reported in 21.8% (n=12/55). Residual HPI included 24 (43.6%) presumed cortisol deficient and 18 (32.7%) central DI patients. Risk factors for postoperative HPI were female gender, age <6 years, headache and preoperative pituitary symptoms. LOS (Median=25.5 ± 12.2 days) was significantly prolonged in patients who required two or more doses of DDAVP [B=13; 95% CI= (1.7-24.3) days] and reduced in patients who had suspected preoperative HPI [B=-19.6; 95% CI= (-31.1, -8.2) days]. CONCLUSIONS Prediction of postoperative HPI in pediatric STTs enhances an early initiation of treatment in PICU and reduces LOS. A meticulous use of IVF and medications supervised by a multidisciplinary team is essential for a favorable outcome.
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Affiliation(s)
- Amir Babiker
- King Abdullah Specialized Children's Hospital, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
| | - Bothainah Alaqeel
- King Abdullah Specialized Children's Hospital, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Ayman Al-Eyadhy
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Pediatrics, King Saud University Medical city, King Saud University, Riyadh, Saudi Arabia
| | - Nawaf A Selayem
- King Abdullah Specialized Children's Hospital, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Sharifah Alissa
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Areej Alsofyani
- King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Emad Masuadi
- King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
| | - Fahad Al Juraibah
- King Abdullah Specialized Children's Hospital, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
| | - Sherif Elwatidy
- Department of Surgery, King Saud University Medical city, King Saud University, Riyadh, Saudi Arabia
| | - Mohamad Maghnie
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
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Basindwah S, Alkhalidi H, Abdelwarith A, Elwatidy S. Ten-year survival in glioblastoma patient with neurofibromatosis type 1: illustrative case. Journal of Neurosurgery: Case Lessons 2022; 3:CASE21630. [PMID: 36130570 PMCID: PMC9379713 DOI: 10.3171/case21630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/06/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Gliomas are commonly detected in patients with neurofibromatosis type 1 (NF1) at an early age. Few patients with NF1 are diagnosed with glioblastoma. The course of management, response to therapy, and prognosis of such patients are unknown. Few reports have shown longer-than-average survival rates for patients with NF1 with glioblastoma. OBSERVATIONS A 27-year-old man with NF1 presented with symptoms of high intracranial pressure. Imaging and pathology showed left frontotemporal glioblastoma. Gross total resection was achieved, and concurrent chemoradiotherapy was administered. Recurrence of tumor was detected 48 months later, and the patient underwent tumor debulking and concurrent chemoradiotherapy. The patient received first-, second-, and third-line chemotherapy (temozolomide, bevacizumab, bevacizumab/irinotecan) with good tolerance and has survived >10 years since then with good functional status. LESSONS This case demonstrates >10 years overall survival of glioblastoma in a patient with NF1. Reports of patients with NF1 with longer survival may be attributed to the young age at diagnosis and relatively better tolerance for therapy. It might also support the growing evidence of a unique subset of glioblastoma associated with NF1 and opens the door for a more molecular targeted therapy in the future.
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Affiliation(s)
| | | | - Ahmed Abdelwarith
- Department of Oncology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Al-Habib A, Alhothali W, Albakr A, Elwatidy S, Alawaji G, Alabdulsalam H, Albadr F, Alkubeyyer M, Abu Jamea A, Awwad W, Ullah A, Fakhouri F, Ajlan A. Effects of compressive lesions on intraoperative human spinal cord elasticity. J Neurosurg Spine 2021; 35:807-816. [PMID: 34416718 DOI: 10.3171/2021.1.spine201482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although evaluating tissue elasticity has various clinical applications, spinal cord elasticity (SCE) in humans has never been well documented. In this study, the authors aimed to evaluate the impact of compression on human SCE in vivo. METHODS The authors prospectively assessed SCE using intraoperative shear wave elastography (SWE). All consecutive patients undergoing spinal cord (SC) decompression (laminectomy or corpectomy) between June 2018 and June 2019 were included. After intraoperative exposure of the patient's dura mater, at least three SWE measurements of the SC and its coverings were performed. Intraoperative neurological monitoring in the form of motor and somatosensory evoked potentials was utilized. Cases were divided into two groups based on the state of SC compression following bone removal (laminectomy or corpectomy): patients with adequate decompression (the decompressed SC group [DCG]) following bone removal and patients with remining compression, e.g., compressing tumor or instability (the compressed SC group [COG]). RESULTS A total of 25 patients were included (8 females and 17 males) with a mean age of 48.28 ± 21.47 years. Most cases were degenerative diseases (10 cases) followed by tumors (6 cases), and the compression was observed at cervical (n = 14), thoracic (n = 9), and conus medullaris (n = 2) levels. The COG (6 cases) expressed significantly higher elasticity values, i.e., greater stiffness (median 93.84, IQR 75.27-121.75 kPa) than the decompressed SC in DCG (median 9.35, IQR 6.95-11.22 kPa, p < 0.001). Similarly, the compressed dura mater in the COG was significantly stiffer (mean ± SD 121.83 ± 70.63 kPa) than that in the DCG (29.78 ± 18.31 kPa, p = 0.042). Following SC decompression in COG, SCE values were significantly reduced (p = 0.006; adjusted for multiple comparisons). Intraoperative monitoring demonstrated no worsening from the baseline. CONCLUSIONS The current study is to the authors' knowledge the first to quantitatively demonstrate increased stiffness (i.e., elasticity value) of the human SC and dura mater in response to external compression in vivo. It appears that SCE is a dynamic phenomenon and is reduced following decompression. Moreover, the evaluation of human SCE using the SWE technique is feasible and safe. Information from future studies aiming to further define SCE could be valuable in the early and accurate diagnosis of the compressed SC.
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Affiliation(s)
- Amro Al-Habib
- 1Division of Neurosurgery, Department of Surgery, College of Medicine
| | - Wajda Alhothali
- 1Division of Neurosurgery, Department of Surgery, College of Medicine
| | | | - Sherif Elwatidy
- 1Division of Neurosurgery, Department of Surgery, College of Medicine
| | - Ghaida Alawaji
- 1Division of Neurosurgery, Department of Surgery, College of Medicine
| | | | - Fahad Albadr
- 1Division of Neurosurgery, Department of Surgery, College of Medicine
| | | | | | | | - Anhar Ullah
- 4Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine; and
| | - Faisal Fakhouri
- 5Department of Biomedical Technology, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrazag Ajlan
- 1Division of Neurosurgery, Department of Surgery, College of Medicine
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Elwatidy S, Alkhathlan M, Alhumsi T, Kattan A, Al-Faky Y, Alessa M. Strategy for surgical excision and primary reconstruction of giant frontal sinus osteoma. Interdisciplinary Neurosurgery 2021. [DOI: 10.1016/j.inat.2020.100905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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9
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Bajunaid K, Alqurashi A, Alatar A, Alkutbi M, Alzahrani AH, Sabbagh AJ, Alobaid A, Barnawi A, Alferayan AA, Alkhani AM, Salamah AB, Sheikh BY, Alotaibi FE, Alabbas F, Farrash F, Al-Jehani HM, Alhabib H, Alnaami I, Altweijri I, Khoja I, Taha M, Alzahrani M, Bafaquh MS, Binmahfoodh M, Algahtany MA, Al-Rashed S, Raza SM, Elwatidy S, Alomar SA, Al-Issawi W, Khormi YH, Ammar A, Al-Habib A, Baeesa SS, Ajlan A. Neurosurgical Procedures and Safety During the COVID-19 Pandemic: A Case-Control Multicenter Study. World Neurosurg 2020; 143:e179-e187. [PMID: 32702490 PMCID: PMC7370909 DOI: 10.1016/j.wneu.2020.07.093] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 12/20/2022]
Abstract
Objective Quantitative documentation of the effects of outbreaks, including the coronavirus disease 2019 (COVID-19) pandemic, is limited in neurosurgery. Our study aimed to evaluate the effects of the COVID-19 pandemic on neurosurgical practice and to determine whether surgical procedures are associated with increased morbidity and mortality. Methods A multicenter case-control study was conducted, involving patients who underwent neurosurgical intervention in the Kingdom of Saudi Arabia during 2 periods: pre-COVID-19 and during the COVID-19 pandemic. The surgical intervention data evaluated included diagnostic category, case priority, complications, length of hospital stay, and 30-day mortality. Results A total of 850 procedures were included, 36% during COVID-19. The median number of procedures per day was significantly lower during the COVID-19 period (5.5 cases) than during the pre-COVID-19 period (12 cases; P < 0.0001). Complications, length of hospital stay, and 30-day mortality did not differ during the pandemic. In a multivariate analysis comparing both periods, case priority levels 1 (immediate) (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.24–2.67), 1 (1–24 h) (OR, 1.63; 95% CI, 1.10–2.41), and 4 (OR, 0.28; 95% CI, 0.19–0.42) showed significant differences. Conclusions During the early phase of the COVID-19 pandemic, the overall number of neurosurgical procedures declined, but the load of emergency procedures remained the same, thus highlighting the need to allocate sufficient resources for emergencies. More importantly, performing neurosurgical procedures during the pandemic in regions with limited effects of the outbreak on the health care system was safe. Our findings may aid in developing guidelines for acute and long-term care during pandemics in surgical subspecialties.
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Affiliation(s)
- Khalid Bajunaid
- Department of Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia; Department of Neurology and Neurosurgery, Montreal Neurological Institute and hospital, McGill University, Montreal, Quebec, Canada
| | - Ashwag Alqurashi
- Neurosurgery Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Alatar
- Neurosurgery Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Alkutbi
- Department of Neurosurgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Anas H Alzahrani
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulrahman J Sabbagh
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdullah Alobaid
- Department of Adult Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulwahed Barnawi
- Department of Neurosurgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | - Ahmed M Alkhani
- Division of Neurosurgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ali Bin Salamah
- Department of Neurosurgery, King Saud Medical City, Riyadh, Saudi Arabia
| | - Bassem Yousef Sheikh
- Vascular Endovascular and Skull Base Neurosurgery, College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Fahad E Alotaibi
- Department of Pediatric Neurosurgery, National Neuroscience institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Faisal Alabbas
- Department of Neurosurgery, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Faisal Farrash
- Department of Neuroscience, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hosam M Al-Jehani
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and hospital, McGill University, Montreal, Quebec, Canada; Department of Neurosurgery, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Husam Alhabib
- Department of Spine Surgery, Dr Sulaiman Alhabib Hospital, Khobar, Saudi Arabia
| | - Ibrahim Alnaami
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Ikhlass Altweijri
- Division of Neurosurgery, Department of Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Isam Khoja
- Department of Neurosurgery, International Medical Center, Jeddah, Saudi Arabia
| | - Mahmoud Taha
- Department of Neurosurgery, King Fahad specialist Hospital, Dammam, Saudi Arabia
| | - Moajeb Alzahrani
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mohammed S Bafaquh
- Department of Adult Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Binmahfoodh
- Neurosciences Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mubarak Ali Algahtany
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Sabah Al-Rashed
- Department of Neurosurgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Syed Muhammad Raza
- Department of Neurosurgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Sherif Elwatidy
- Neurosurgery Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Soha A Alomar
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Wisam Al-Issawi
- Department of Neurosurgery, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Yahya H Khormi
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Ahmad Ammar
- Department of Neurosurgery, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Amro Al-Habib
- Neurosurgery Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saleh S Baeesa
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulrazag Ajlan
- Neurosurgery Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Khurayzi T, Jan B, Bedaiwi R, Ajlan A, Elwatidy S, Alhabib S, Alsanosi A. Otogenic Pneumocephalus After Tegmen Bone Reconstruction: A Case Report. Ear Nose Throat J 2020; 101:15-19. [PMID: 32543228 DOI: 10.1177/0145561320934217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pneumocephalus is usually induced by trauma, infections, tumors of the skull base, and surgical interventions. Spontaneous pneumocephalus occurs due to a defect in the temporal bone with no obvious cause. Few cases have been reported with spontaneous otogenic pneumocephalus. However, delayed postoperative pneumocephalus is rarely reported in the literature. Here, we present a case of otogenic pneumocephalus through Eustachian tube (ET) preceded by nose blowing 10 days after surgical treatment of meningoencephalocele of the right middle ear (ME) cleft and reconstruction of tegmen and dural defects. Pneumocephalus was provoked by decreased intracranial pressure (ICP) secondary to placement of lumbar drain, which caused direct communication between unsutured dural defect and the defective posterior wall of external auditory canal skin. A revision surgery of combined transmastoid/middle cranial fossa approach was performed for intracranial decompression followed by appropriate closure by suturing the dura, obliterating the ET and ME.
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Affiliation(s)
- Tawfiq Khurayzi
- Department of Otorhinolaryngology-Head and Neck Surgery, King Abdullah Ear Specialist Center (KAESC), King Saud University, Riyadh, Saudi Arabia
| | - Bayan Jan
- Department of Otorhinolaryngology-Head and Neck Surgery, King Abdullah Ear Specialist Center (KAESC), King Saud University, Riyadh, Saudi Arabia
| | - Reenad Bedaiwi
- Department of Otorhinolaryngology-Head and Neck Surgery, King Abdullah Ear Specialist Center (KAESC), King Saud University, Riyadh, Saudi Arabia
| | - Abdulrazag Ajlan
- Department of Neurosurgery, King Saud University, Riyadh, Saudi Arabia
| | - Sherif Elwatidy
- Department of Neurosurgery, King Saud University, Riyadh, Saudi Arabia
| | - Salman Alhabib
- Department of Otorhinolaryngology-Head and Neck Surgery, King Abdullah Ear Specialist Center (KAESC), King Saud University, Riyadh, Saudi Arabia
| | - Abdurrhaman Alsanosi
- Department of Otorhinolaryngology-Head and Neck Surgery, King Abdullah Ear Specialist Center (KAESC), King Saud University, Riyadh, Saudi Arabia
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Almujaiwel N, Alsager G, Abdulqader S, Malik S, Elwatidy S. Patient satisfaction with neurosurgical care at King Saud University Medical City. J Nat Sci Med 2020. [DOI: 10.4103/jnsm.jnsm_26_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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AlQazlan S, Albakr A, Al Towim A, Alsaadan Y, Hassan H, Aljerian K, Elwatidy S. Aggressive surgical management of recurrent intracranial juvenile xanthogranuloma: case report and review of the literature. Childs Nerv Syst 2020; 36:213-217. [PMID: 31385088 DOI: 10.1007/s00381-019-04323-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/28/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Juvenile xanthogranuloma (JXG) with the central nervous system (CNS) involvement is a rare disease entity that remains poorly understood, especially when the condition develops following treatment for Langerhans cell histiocytosis (LCH). CASE REPORT A 21-year-old man who was diagnosed with LCH at age 2, several years following which he developed signs and symptoms of CNS involvement. Magnetic resonance imaging (MRI) of the brain revealed JXG with bilateral choroid plexus involvement. As radiation therapy for the intraventricular masses proved unsuccessful, he underwent two surgical resections. In the following years, he developed another large JXG in the meninges, which was managed conservatively until he required surgery due to symptom progression. Twelve years after the first surgery, the patient is in stable condition with no evidence of recurrence. CONCLUSION Due to the rarity of JXG in the CNS, optimal treatment strategies and the precise duration of therapy remain to be determined. Future studies should aim to develop an appropriate treatment algorithm for such rare cases.
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Affiliation(s)
- Salman AlQazlan
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman Albakr
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia. .,Division of Neurosurgery, Department of Neurosciences, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada.
| | - Abdullah Al Towim
- Department of Neurosurgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Yazeed Alsaadan
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hamdy Hassan
- Department of Radiology and Medical Imaging, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khaldoon Aljerian
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sherif Elwatidy
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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13
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Al Abdulsalam H, Alhothali W, Alkhalidi H, Orz Y, Alobaid A, Bafaqeeh M, Shaffi Ahamed S, Hussain S, Albader F, AlSaeed E, Ibrahim A, Abdel Warith A, Alomair A, Altewaijri I, Elwatidy S, Al-Habib A, Ajlan A. INNV-02. ARE WE AGGRESSIVE WITH OUR GLIOBLASTOMA PATIENTS: A PROPOSED TOOL TO EVALUATE CENTERS ATTITUDES IN TREATMENT OF GLIOBLASTOMA. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
INTRODUCTION
Glioblastoma is the most common malignant primary brain tumor in adults. Optimal treatment for glioblastoma requires a multidisciplinary approach and knowledge of complications from both the disease and its treatment. Despite modern advances in the standards of care, the outcome in patients with Glioblastoma remains poor. Thus, it is crucial to optimize treatment strategies to improve over-all survival in patients with Glioblastoma, with the therapeutic challenge of “how aggressive a physician should be?” OBJECTIVES: We herein propose a novel method to compare aggressiveness in the standard of care between multiple centers, using a novel tool, and provide a more precise cut-off definition of aggressiveness.
METHOD
Multiple centers were included. A novel case-based questionnaire was generated which included only certain parameters, and then sent and answered jointly by tumor board members from each center. We then stratified centers into more aggressive vs. less aggressive based on our proposed Aggressiveness (AS) score.
RESULTS
In our novel cases, center A scored an AS score of 44 (Mean ± SD; 3.67 ± 1.07), while center B scored 49 (Mean ± SD; 4.08 ± 0.90) In real cases, center A scored 40 (Mean ± SD; 3.25 ± 1.42), while center B scored 44 (Mean ± SD; 3.75 ± 1.29). Our results showed consistency between centers evaluated using our tool. Age and presence of comorbidities were the most influential parameters.
CONCLUSION
In the current study, we present a novel and a reliable tool that can be easily used and replicated to compare aggressiveness in the treatment of Glioblastoma between multiple centers. The methodology we used has never been previously proposed and can serve as a novel concept to compare aggressiveness in treatment of all incurable diseases that require a multidisciplinary approach.
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Affiliation(s)
| | | | | | - Yasser Orz
- King Fahad Medical City, Riyadh, Saudi Arabia
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Elwatidy S. Fontal Sinus Osteoma: A Huge Craniofacial Tumor Preoperative Planning and Strategy of Surgical Excision and Reconstruction. Skull Base Surg 2016. [DOI: 10.1055/s-0036-1580013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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15
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Elwatidy S, Albakr A, Malik S. Different Approaches and Outcome of Surgery for Tumors of the Lateral and Third Ventricle: an Institutional Series of 42 Patients. Skull Base Surg 2016. [DOI: 10.1055/s-0036-1579899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Elwatidy S. Giant Craniofacial Osteoma: Preoperative Planning and Strategy of Surgical Excision and Reconstruction. Skull Base Surg 2016. [DOI: 10.1055/s-0036-1580050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Elwatidy S, Jamjoom Z, Malik S. Is Pterional Craniotomy Adequate for Complete Excision of Olfactory Groove Meningioma. Skull Base Surg 2015. [DOI: 10.1055/s-0035-1546475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Elwatidy S. Bifrontal Decompressive Craniectomy is a Life Saving Procedure for Patients with Nontraumatic Refractory Brain Edema. Skull Base Surg 2014. [DOI: 10.1055/s-0034-1384089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Elwatidy S. Is Pterional Craniotomy Adequate for Complete Excision of Olfactory Groove Meningioma. Skull Base Surg 2014. [DOI: 10.1055/s-0034-1383989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Elwatidy S. Craniopharyngioma: Analysis of Factors that Affect the Outcome. Skull Base Surg 2013. [DOI: 10.1055/s-0033-1336346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Elwatidy S, Jamjoom Z, Jamjoom A, Murshid W, Elgamal E. Anterior Cranial Fossa Meningioma: Outcome of Surgery Using Different Surgical Approaches. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1313944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Elwatidy S, Jamjoom Z, Elgamal E. Is the Retrosigmoid Approach Adequate for Resection of Petroclival Meningiomas? Skull Base Surg 2012. [DOI: 10.1055/s-0032-1314233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Elwatidy S, Jamjoom Z, Riyadh W. Anterior Cranial Fossa Meningioma, Outcome of Surgery Using Different Surgical Approaches. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1312203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Elwatidy S, Jamjoom Z. Is Retrosigmoid Approach Adequate for Resection of Petroclival Meningiomas? Skull Base Surg 2012. [DOI: 10.1055/s-0032-1312291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Elwatidy S, Jamjoom Z, Elgamal E, Abdelwahab A. Management strategies for acute brain lesions presenting during pregnancy: a case series. Br J Neurosurg 2011; 25:478-87. [DOI: 10.3109/02688697.2010.550345] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Elwatidy S. Bifrontal decompressive craniectomy is a life-saving procedure for patients with nontraumatic refractory brain edema. Br J Neurosurg 2009; 23:56-62. [DOI: 10.1080/02688690802571094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Elgamal EA, Elwatidy S, Zakaria AM, Abdel-Raouf AA. Spinal cord injury without radiological abnormality (SCIWORA). A diagnosis that is missed in unconscious children. Neurosciences (Riyadh) 2008; 13:437-440. [PMID: 21063386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Spinal cord injury without radiographic abnormality (SCIWORA) usually occurs in the hypermobile, immature cervical spine of young children. In a comatose child, a normal spine x-ray, and CT scan exclude most cases of gross fracture and dislocation, but not SCIWORA. We present 2 children that sustained a polytrauma, which rendered each of them unconscious at the outset. In both, cervical spine x-ray excluded bony injuries, however, CT scan raised the suspicious of spinal cord injury in one, and MRI demonstrated significant cord injury in both. The first patient died from severe head and cervical spinal cord injury. The second patient recovered with mild Brown-Sequard syndrome. A high index of suspicious of SCIWORA is necessary in injured comatose children in whom movement of all limbs is not seen. Therefore, spine MRI should be considered if they are expected to remain ventilated for an unknown time.
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Affiliation(s)
- Essam A Elgamal
- Neurosurgery Division (37), College of Medicine, King Khalid University Hospital, PO Box 7805, Riyadh 11472, Kingdom of Saudi Arabia. Tel. +966 (1) 4671273. Fax: +966 (1) 4679493. E-mail:
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28
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Zakaria A, Elwatidy S, Elgamal E. Nocardia brain abscess: severe CNS infection that needs aggressive management; case report. Acta Neurochir (Wien) 2008; 150:1097-101; discussion 1101. [PMID: 18773137 DOI: 10.1007/s00701-008-0026-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 05/30/2008] [Indexed: 10/21/2022]
Abstract
Nocardia brain abscess is a rare central nervous system (CNS) infection that carries a high mortality rate reaching 34% which is considered the highest amongst brain abscesses caused by microorganisms. All available literature is in the form of retrospective studies and small case series. In this case report the authors present a patient whose course of disease was stormy and required multiple neurosurgical procedures. The clinical outcome, long-term follow up and a review of the literature is discussed.
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Elwatidy S. Bifrontal decompressive craniotomy for malignant brain edema. Neurosciences (Riyadh) 2006; 11:241-247. [PMID: 22266430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To review the outcome of bifrontal decompressive craniotomy used for the treatment of malignant brain edema due to different etiologies. METHODS The study was carried out at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia during the period from January 2000 to June 2005, and included all patients who had malignant brain edema due to different etiology and were treated with bifrontal decompressive craniotomy after failure of aggressive medical treatment. RESULTS Ten patients were included in the study, 6 males and 4 females; the mean age was 24 years. Seven patients had severe head injury, 2 had aneurysmal subarachnoid hemorrhage, and one had large calcified olfactory groove meningioma. Clinically, all patients, except one, had Glasgow coma scores more than 3 before surgery, and operation was performed in all patients once clinical deterioration was observed and diagnosis confirmed by CT brain scan. The outcome of surgery was good in 70%, poor in 20%, and mortality was 10%. The mean hospital stay was 85 days. CONCLUSION Bifrontal decompressive craniotomy offers immediate reduction of intracranial pressure to its normal levels, and improves the outcome of malignant brain edema whatever its cause, it should be performed once clinical deterioration is observed.
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Affiliation(s)
- Sherif Elwatidy
- Division of Neurosurgery, King Khalid University Hospital, College of Medicine, King Saud University, PO Box 7805, Riyadh 11472, Kingdom of Saudi Arabia. Tel. +966 (1) 4671575. Fax. +966 (1) 4679493. E-mail:
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30
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Elwatidy S. Bifrontal decompressive craniotomy for malignant brain edema. Saudi Med J 2006; 27:1547-53. [PMID: 17013481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVE To review the outcome of bifrontal decompressive craniotomy used for the treatment of malignant brain edema due to different etiologies. METHODS The study was carried out at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia during the period from January 2000 to June 2005, and included all patients who had malignant brain edema due to different etiology and were treated with bifrontal decompressive craniotomy after failure of aggressive medical treatment. RESULTS Ten patients were included in the study, 6 males and 4 females; the mean age was 24 years. Seven patients had severe head injury, 2 had aneurysmal subarachnoid hemorrhage, and one had large calcified olfactory groove meningioma. Clinically, all patients, except one, had Glasgow coma scores more than 3 before surgery, and operation was performed in all patients once clinical deterioration was observed and diagnosis confirmed by CT brain scan. The outcome of surgery was good in 70%, poor in 20%, and mortality was 10%. The mean hospital stay was 85 days. CONCLUSION Bifrontal decompressive craniotomy offers immediate reduction of intracranial pressure to its normal levels, and improves the outcome of malignant brain edema whatever its cause, it should be performed once clinical deterioration is observed.
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Affiliation(s)
- Sherif Elwatidy
- Division of Neurosurgery, King Khalid University Hospital, College of Medicine, King Saud University, PO Box 7805, Riyadh 11472, Kingdom of Saudi Arabia.
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31
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Elwatidy S. Prediction of outcome of subarachnoid hemorrhage. A proposed scoring system. Neurosciences (Riyadh) 2003; 8:225-228. [PMID: 23648884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The aim of this study was to identify factors that affect the outcome of patients with aneurysmal subarachnoid hemorrhage treated at King Khalid University Hospital (KKUH), Riyadh, Kingdom of Saudi Arabia. METHODS The medical records of 30 consecutive patients with verified ruptured cerebral aneurysm treated at KKUH between 1993 and 1996 were reviewed looking for factors that affect the outcome of surgery. Statistically significant factors were selected to design a scoring system for prediction of the outcome. This scoring system was then used to predict the outcome of the next 40 patients between 1997 and 2000. RESULTS The preoperative Hunt and Hess grade, amount of subarachnoid hemorrhage in computerized tomography scan, aneurysm size and progressive hydrocephalus were the most significant factors that affect the outcome. There was significant association between the score value and the outcome, patients with low scores had negligible morbidity and mortality. CONCLUSION The scoring system is simple, easily applicable and can be used to predict the outcome of patients with aneurysmal subarachnoid hemorrhage with a high degree of accuracy.
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Affiliation(s)
- Sherif Elwatidy
- Department of Surgery, Division of Neurosurgery, King Khalid University Hospital, Riyadh 11472, Kingdom of Saudi Arabia. Tel. +966 (1) 4671575. Fax. +966 (1) 4679493. E-mail:
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