Egyptian journal of neurosurgery最新文献

{"title":"Anterior cervical discectomy and fusion with and without plating versus laminectomy with and without fusion for multilevel cervical spondylotic myelopathy: a prospective observational study","authors":"Omar El Farouk Ahmed, Salah A. Hemida, Tarek H. Elserry, Wael Ashour, Abdelrahman Elgayar","doi":"10.1186/s41984-024-00309-1","DOIUrl":"https://doi.org/10.1186/s41984-024-00309-1","url":null,"abstract":"Cervical spondylotic myelopathy (CSM) is a chronic progressive spinal compression that usually accompanies age-related degeneration of the cervical spine and represents one of the most common causes of spinal cord dysfunction. Surgical intervention is the foundation of management in symptomatic cases, but the approach of choice is constantly contentious. The aim of this study is to evaluate and appraise different surgical approaches for multilevel cervical spondylotic myelopathy (anterior cervical discectomy and fusion (ACDF) with or without plating and laminectomy with and without fusion) regarding the perioperative data, clinical outcomes, complications rates and radiographic parameters. In this prospective study, sixty patients in four matched cohorts were followed up. The first group (n = 15) underwent ACDF only, the second group (n = 15) underwent ACDF with anterior plate, the third group (n = 15) underwent laminectomy alone, and the fourth group (n = 15) underwent laminectomy with lateral mass fusion. Patients were followed up for twelve-month duration using modified Japanese orthopedic score (mJOA), neck disability index (NDI), visual analogue scale (VAS) and short form 36 (SF-36) in addition to measurement of C2-C7 cobb`s angle to evaluate postoperative cervical sagittal alignment. All the four groups were associated with functional clinical improvement with no statistically significant differences between them. Postoperative cervical lordosis and its change were highest in anterior groups, both plated (11.1 ± 5.2a, 5.1 ± 4.0a) and non-plated (12.0 ± 5.3a, 4.4 ± 3.2a) (p value < 0.001) with no significant difference between them. Postoperative quality of life score and its change were significantly better in plated anterior approach (55.8 ± 4.8a, 21.6 ± 4.9a) and in non-plated (55.6 ± 3.2a, 21.3 ± 4.0a) (p value < 0.001) with no significant difference between both techniques. Operative time was statistically higher in plated anterior approach (202.1 ± 55.9b) and in laminectomy with fusion (229.2 ± 92.9b) (p value < 0.001) with no statistically significant difference between either group. Posterior approaches were associated with significantly higher intraoperative blood loss (280.0 ± 52.3b for laminectomy and 310.0 ± 60.3b for laminectomy with fusion) (p value < 0.001) with no difference between both techniques. Hospital stay was higher in posterior groups as well, but it was not statistically significant (p value = 0.127). Both anterior and posterior approaches were associated with significant functional improvements with no difference in complications severity or frequency. Anterior surgery had shorter hospital stay and less blood loss with better quality of life scores and more successful restoration of cervical lordosis.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141754113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shunt-related brain tumor, a case report presenting a rare complication and review of literature","authors":"Michael Zohney, Mohamed M Aziz, Shebl Izz-alarab, Ahmed A Algredly, Abdelaleem Abdelwahab","doi":"10.1186/s41984-024-00313-5","DOIUrl":"https://doi.org/10.1186/s41984-024-00313-5","url":null,"abstract":"Congenital hydrocephalus is a well-known neurosurgical condition in the pediatric age group. Ventriculoperitoneal shunt (VPS) placement is a standard procedure with a high incidence of complications in the first year postoperatively. We present a very rare complication, with only a few reported cases in the accessible literature, in which a tumor arises in relation to a shunt catheter. A case report. We describe a case of a VPS placement in an eleven-month-old boy who, at the age of thirteen, presented with a two-month period of convulsions caused by a cortical mass related to the shunt catheter. Surgical excision of the mass revealed atypical meningioma (WHO Grade 2). The tumor may have been initiated by direct irritation of the shunt catheter or just an unfortunate simultaneous event for this child. Further analysis is needed to determine which factors could have led to such a complication and to predict its occurrence in future patients. In this case, the pathologic features, duration, and unusual radiologic findings are interesting and unique.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141743136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical outcome of endoscopic endonasal approach as a modality of management for large and giant pituitary adenomas: a retrospective case series","authors":"Shebl Izz-alarab, Michael Zohney, Saied A. Issa, Abdelaleem Abdelwahab, Ashraf G. Al-Abyad, Mohamed M. Aziz","doi":"10.1186/s41984-024-00311-7","DOIUrl":"https://doi.org/10.1186/s41984-024-00311-7","url":null,"abstract":"Large and giant pituitary adenomas (defined as tumors of maximal diameter ≥ 3–3.9 cm and ≥ 4 cm, respectively) present considerable surgical challenges regarding the extent of resection and perioperative morbidity. Endoscopic endonasal resection is considered the most effective treatment for pituitary adenomas. It allows for better visualization, maneuverability, and access to distant and lateral tumor compartments, ultimately enhancing the extent of resection. This article evaluates our initial experience with endoscopic endonasal resection of large and giant pituitary adenomas. The clinical outcomes, perioperative complications, and extent of tumor resection would be specifically addressed. The primary goal of surgery was to decompress the optic pathways, and the secondary goals were to achieve maximal safe resection and hormonal control in hormone-secreting adenomas. The degree of tumor resection was classified as gross-total resection (100%), near-total resection (90–100%), subtotal resection (70–90%), and partial resection (< 70%). 42 patients were included in this study. A good visual outcome achieved with 80% improvement in visual symptoms. Gross-total resection (GTR) was achieved in 19 patients (45.2%), near-total resection (NTR) was achieved in 12 patients (28.6%), subtotal resection (STR) in 6 patients (14.3%), and partial resection in the remaining 5 patients (11.9%). Subgroup analysis revealed that GTR, NTR rates were higher in large, compared to giant tumors. GTR, NTR rates of large adenomas were 59.3%, and 29.6%, compared to 20%, and 26.7% in giant adenomas respectively (p-value: 0.01428). Surgical complications were observed in 19 patients (45.2%) with CSF leakage being the most common complication (11 patients, 26.2%). Post-operative diabetes insipidus was observed in 5 patients (11.9%), major vascular injury in one case (2.4%), transient post-op 6th nerve palsy observed in 3 patients (7.1%), while two patients (4.8%) presented with post-operative paranasal sinuses infection. Endoscopic endonasal transsphenoidal resection of large and giant pituitary adenomas is a safe and efficient procedure. Large adenomas (3–3.9 cm) have excellent resection rates and lower complications than giant adenomas (≥ 4 cm), which may require extending our approach to achieve more tumor resection rates in the future. However, only adequate resection of these giant adenomas can be enough to achieve the main surgical goals of visual improvement, hormonal control, and decompression of surrounding structures.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141612350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of normal saline versus isotonic balanced crystalloid on acid–base balance and renal functions in patients undergoing intracranial tumor resection surgeries","authors":"Renu Bala, Akanksha, Vandna Arora, Divyansh Yadav, Ankur Singh","doi":"10.1186/s41984-024-00312-6","DOIUrl":"https://doi.org/10.1186/s41984-024-00312-6","url":null,"abstract":"Normal saline (NS) infusion in large volumes may result in hyperchloremic metabolic acidosis and renal compromise. Balanced crystalloid (BC) with physiochemical composition akin to that of plasma may avoid these problems associated with NS. The present study aimed to evaluate effects of NS versus BC on acid–base balance and renal functions in patients undergoing intracranial tumor resection surgeries. Fifty adult patients scheduled to undergo elective neurosurgery for intracranial tumor resection were randomized to receive either NS or BC as intraoperative or maintenance fluid. Metabolic and renal parameters were estimated prior to induction (baseline), at 1 h and 2 h after induction, at the end of surgery and 4 h after extubation. Serum neutrophil gelatinase-associated lipocalin (NGAL) was measured postoperatively. Brain relaxation score was assessed by the operating surgeon. Baseline values of variables were similar between the groups. At rest of the observed time-points, pH was significantly lower, while blood urea, serum creatinine, sodium, chloride, NGAL and plasma osmolality were significantly higher in the NS group as compared to the BC group. Brain relaxation score, serum bicarbonate and base excess were comparable between the two groups. Use of balanced crystalloid (plasmalyte) resulted in better metabolic and renal profile as compared to normal saline in neurosurgical patients.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141584939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gamma knife radio surgery for cerebral arteriovenous malformation (AVM) in children: a systematic review and meta-analysis of clinical outcomes","authors":"William Andrés Florez-Perdomo, Juan Sebastián Reyes Bello, Luis Rafael Moscote Salazar, Amit Agrawal, Tariq Janjua, Vishal Chavda, Ezequiel García-Ballestas, Ebtesam Abdulla","doi":"10.1186/s41984-024-00307-3","DOIUrl":"https://doi.org/10.1186/s41984-024-00307-3","url":null,"abstract":"This article aims to evaluate the safety and effectiveness of Gamma Knife radiosurgery as a treatment modality for pediatric cerebral arteriovenous malformations (AVMs) by assessing mortality rates, the rate of complete AVM obliteration, and the incidence of complications while exploring potential risk factors. A comprehensive search was conducted through multiple databases to identify relevant studies, including randomized controlled trials and observational studies. The studies were assessed for risk of bias using the ROBINS-I tool and methodological quality with the Newcastle–Ottawa Scale. Data on mortality, AVM obliteration rates, and complications were systematically extracted. Pooled rate analysis was performed to assess outcomes, and heterogeneity was evaluated. The analysis included 21 studies involving 2142 pediatric patients with cerebral AVMs. A low mortality rate of 0.75% (95% CI 0.09% to 2.71%) and a high rate of complete obliteration of AVMs was observed, with a rate of 71.64% (95% CI 65.716% to 77.211%). Complications, including new neurological deficits, post-radiosurgery intracranial hemorrhage, and other complications (such as seizures and radiation-related issues), were relatively low, with rates of 2.57%, 2.463%, and 4.784%, respectively. Gamma Knife radiosurgery demonstrates its potential as a safe and effective treatment option for pediatric cerebral AVMs. The low mortality rate and high rate of AVM obliteration suggest that this approach offers significant benefits. While some complications were observed, they were generally non-severe. However, further high-quality studies with extended follow-up periods are needed to better understand long-term efficacy and safety.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141550835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor regarding medical students’ perception toward neurosurgery as a career: a cross-sectional study","authors":"Krish Kuhar, Bipin Chaurasia","doi":"10.1186/s41984-024-00293-6","DOIUrl":"https://doi.org/10.1186/s41984-024-00293-6","url":null,"abstract":"<p>Kaleem et al. [1] in this engrossing article presented an overview of perception of medical students toward the field of neurosurgery and enrolling in neurosurgical training programs. This article provides an insight into the mindset of undergraduates and may guide the institutions to meet the demands of aspirants. The study also attempts to fill the knowledge gap and motivate the young minds to pursue an influential career in neurosurgery.</p><p>In a similar context, the study conducted by Mokhtari et al. [2] described the perspective of medical students in Iran to opt for residency in neurosurgery and indicated that female decisions were particularly influenced by duration of residency, number of on-calls and stress levels. Chan et al. [3] in his research in the Philippines concluded that merely 18.7% students were interested in pursuing neurosurgery as a career. Balogun et al. [4] in his study appreciated the willingness of final year medical students of Nigeria to enroll in neurosurgery and concluded that the number of interested candidates is low and sex disparity profoundly exists.</p><p>These studies recognize the extensive efforts by the world neurosurgery community to comprehend the outlook and inclination of medical students toward opting neurosurgery as a career branch and imply that paramount changes are required to draw more students and increase workforce in neurosurgery.</p><p>The fundamental objective of this article is to assess the status of perception and apprehension of contemporary medical undergraduates regarding neurosurgery as a branch and to highlight the necessity of exposure to neurosurgery before graduation.</p><p>However, we do not completely agree with the results of the study as it majorly involves some of students leaving out more than half of the total medical student’s population and thus deviating the study from yielding effective conclusions. Further, even if the database was collected after face and content validation, being an online questionnaire survey, renders the source passive for reliable results.</p><p>One of the similar study done by Shah et al. [5] concluded that almost 60% of the respondents are willing to consider neurosurgery as a career option, but in our opinion this cannot be held entirely true. It can be understood from an analogy that when students are questioned about opting a stream after high school, a vast majority of students prefers to select the branch which seems alluring among their peers, but eventually they may end up choosing another branch after achieving proper exposure and assessing their personal requirements. Thus, compatibility of a branch can only be concluded after its adequate exposure.</p><p>We completely agree with the author that exposure to neurosurgery is negligible in the medical curriculum of undergraduates. Zukerman et al. [6] in his study also elucidated the crucially of neurosurgery electives for preclinical medical students.</p><p>Further, it is adequately h","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141506476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subthalamic deep brain stimulation in advanced Parkinson’s disease using the STarFix system","authors":"Amr Elnaggar, Ahmad Elshanawany, Ahmad Ebrahim Elgheriany, Mahmoud Hasan Ragab, Ahmad Radwan Nouby","doi":"10.1186/s41984-024-00281-w","DOIUrl":"https://doi.org/10.1186/s41984-024-00281-w","url":null,"abstract":"Deep brain stimulation (DBS) is a well-established and highly effective treatment for patients with medically uncontrolled Parkinson’s disease (PD). This study presents the outcome of patients with PD after subthalamic deep brain stimulation (STN DBS) using the microtargeting the platform (MTP) stereotactic system (the STarFixSystem, FHC Inc., Bowdoin, Me., USA) for accurate localization of the target and precise placement of DBs electrodes. Patients were evaluated preoperatively and the follow up period was 1 year utilizing the Unified Parkinson’s Disease Rating Scale (UPDRS II and III) in on and off medication-stimulation conditions. It included 18 STN DBS procedures in 10 patients over a 2-year period. The technical features and the practical application of the STarFix system and the clinical outcome are reported. Also lead location analysis is done by doing postoperative CT to evaluate the clinical accuracy of the stereotactic system. The mean age of PD patients was 67.7 years. Six patients were males (60%) and 4 patients were females (40%). The mean postoperative improvement in ADL was 83.47 ± 2.39 over Dopa therapy alone. The mean postoperative improvement in UPDRs motor score was 78.96 ± 7.74 over Dopa therapy alone. The STarFix system showed high accuracy with target error 1.89 mm (SD 0.8) without accounting for brain shift. Deep brain stimulation (DBS) targeting the subthalamic nucleus (STN) offers fundamental benefits for patients with advanced Parkinson’s disease (PD). The usage of the STarFix system for implanting DBS electrodes in the STN provides an accurate, safe, and effective alternative to traditional stereotactic techniques. This approach simplifies the surgical procedure, boosts patient comfort, and minimizes the duration of the operation. Clinical trial registration ClinicalTrials.gov identifier: NCT03562403. Registered 19 June 2018, https://classic.clinicaltrials.gov/ct2/show/NCT03562403 .","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141506477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early and midterm efficacy of oxiplex gel on postoperative pain intensity, physical disability, and musculoskeletal power in patients undergoing lumbar discectomy","authors":"Alireza Tabibkhooei, Maziar Azar, Mohsen Nabiuni, Javid Jahandideh, Mohsen Benam, Farid Qoorchi Moheb Seraj, Feizollah Ebrahimnia, Ali Moradi","doi":"10.1186/s41984-024-00266-9","DOIUrl":"https://doi.org/10.1186/s41984-024-00266-9","url":null,"abstract":"Carboxymethylcellulose/polyethylene oxide, also known as Oxiplex gel, is commonly used during lumbar discectomy operations. It serves to cover the surgical site, preventing adhesions and providing relief from pain and symptoms. However, there is ongoing debate regarding the extent of its beneficial effects on postoperative pain intensity, level of disability, and overall improvement of musculoskeletal conditions. Therefore, the objective of this study is to evaluate the advantages and limitations of using Oxiplex gel in lumbar laminectomy procedures specifically for herniated discs. A randomized controlled trial was conducted on 56 consecutive patients who were candidates for unilateral lumbar discectomy on one lumbar surface. The patients were chosen based on their clinical manifestations and imaging findings. After the initial assessment, the patients underwent either laminectomy or laminotomy surgery. Following the surgery, the patients were randomly assigned to either the intervention group (receiving Oxiplex gel) or the control group. This assignment was done using a computerized random number generator. Assessments were conducted before the operation, as well as 3 and 6 months post-surgery for all patients. There was no significant difference found between the Oxiplex gel and control groups in terms of radicular and low back pain intensity, as well as disability scores, at different time points after surgery (p = 0.336, p = 0.65, and p = 0.336, respectively). Additionally, there were no significant differences found in the prevalence of sexual or sphincteric disorders between the two groups during postoperative assessments (p = 0.639 and p = 0.15, respectively). Furthermore, no significant differences were observed in the results of the postsurgical neuromuscular evaluation under different lower extremities conditions between the two groups. Based on our findings, it was observed that Oxiplex gel did not demonstrate any improvement in post-unilateral lumbar discectomy symptoms or musculoskeletal power.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141506478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival rate of patient with glioblastoma: a population-based study","authors":"M. Sabouri, Aref Famili Dogonchi, Mehdi Shafiei, Donya Shaybeni Tehrani","doi":"10.1186/s41984-024-00294-5","DOIUrl":"https://doi.org/10.1186/s41984-024-00294-5","url":null,"abstract":"","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141376701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of spontaneous pyogenic spondylodiscitis: a descriptive cohort study","authors":"Aly Ibrahim, Khaled Elshazly, Mohamed A. R. AbdelFatah, Abdelrahman El-Gayar, Sameh Hefny","doi":"10.1186/s41984-024-00299-0","DOIUrl":"https://doi.org/10.1186/s41984-024-00299-0","url":null,"abstract":"Spontaneous spondylodiscitis (SD) is an inflammation of the vertebral endplate and the intervertebral disc with no prior surgery or intervention. The treatment of spontaneous pyogenic SD mainly consists of systemic antibiotics and rest. Some cases require surgery due to failure of medical treatment or due to neurological compromise. Due to the disease heterogeneity, there are no standardized, widely adopted treatment protocols. We conducted this study to assess the clinical outcome of the different treatment modalities. This is a retrospective analysis of prospectively collected data of patients with spontaneous non-tuberculous spondylodiscitis. Thirty-eight patients were identified, including 14 males and 24 females. The mean age was 49 years. Twenty-three patients underwent surgery from the start while 15 patients received conservative medical treatment. Among the latter, 8 patients showed disease progression and required surgical intervention. The ODI/NDI at 1 year (mean = 8) was significantly better than before treatment (mean = 18). Among 11 patients with motor deficit at presentation, 8 improved and 3 remained stable. There were 14 complications, including 11 minor and 3 major, requiring one revision surgery. Surgical decompression and debridement with or without instrumented fusion for complicated SD cases is a safe and effective treatment modality. Close follow-up is needed in case of conservative treatment for early detection of treatment failure and disease progression. Baseline characteristic variabilities in patients with spontaneous pyogenic SD could predict conservative treatment failure, but this needs to be validated in larger series.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141252237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}