Walid Attia - Academia.edu (original) (raw)

Papers by Walid Attia

Research paper thumbnail of Brown Tumor of the Cervical Spines: A Case Report with Literature Review

Asian Spine Journal, 2015

Research paper thumbnail of Cases

Neurosurgery Rounds: Questions and Answers, 2011

Research paper thumbnail of Accuracy of Percutaneous Pedicle Screw Insertion Technique with Conventional Dual Fluoroscopy Units and a Retrospective Comparative Study Based on Surgeon Experience

Global Spine Journal, 2016

Study Design Retrospective comparative study. Objective To evaluate the accuracy of percutaneous ... more Study Design Retrospective comparative study. Objective To evaluate the accuracy of percutaneous pedicle screw (PPS) placement and intraoperative imaging time using dual fluoroscopy units and their differences between surgeons with more versus less experience. Methods One hundred sixty-one patients who underwent lumbar fusion surgery were divided into two groups, A ( n = 74) and B ( n = 87), based on the performing surgeon's experience. The accuracy of PPS placement and radiation time for PPS insertion were compared. PPSs were inserted with classic technique under the assistance of dual fluoroscopy units placed in two planes. The breach definition of PPS misplacement was based on postoperative computed tomography (grade I: no breach; grade II: <2 mm; grade III: ≤2 to <4 mm). Results Of 658 PPSs, only 21 screws were misplaced. The breach rates of groups A and B were 3.3% (grade II: 3.4%, grade III: 0%) and 3.1% (grade II: 2.6%, grade III: 0.6%; p = 0.91). One patient in gra...

Research paper thumbnail of Treatment of chronic bilateral facet dislocation in a 6-year-old: A case report

SAGE open medical case reports, 2018

Objectives: Spine injuries seldom affect the subaxial spine in children less than 9 years of age.... more Objectives: Spine injuries seldom affect the subaxial spine in children less than 9 years of age. We describe the management of a chronic paediatric bilateral facet dislocation. Methods: Case report and literature review. A 6-year-old boy presented 10 weeks after a motor vehicle collision with bilateral C4-C5 malunited facet dislocation. He had an incomplete spinal cord injury; right brown sequard hemiplegia, Frankel grade D. Results: Surgical management was through posterior-anterior-posterior approach without preoperative skull traction. Two years postoperatively, the child was asymptomatic, ambulating and functioning well. The injury had healed in radiographs. Conclusion: A combined approach for chronic bilateral facet dislocation applies to the paediatric age group to realign the spine.

Research paper thumbnail of Brucellosis of the spine – A global public health problem - An analysis of 37 patients from a ‘high risk’ region

Journal of clinical orthopaedics and trauma, Mar 1, 2023

Research paper thumbnail of Brucellosis of the Spine in Children—An Analysis of 5 Children From an Endemic Setting

International Journal of Spine Surgery, 2021

Background: Brucellosis of the spine is quite common among adults in endemic regions. The inciden... more Background: Brucellosis of the spine is quite common among adults in endemic regions. The incidence of brucellosis of the spine affecting children is very rare. This article describes the clinical characteristics, diagnosis, management and outcome of children with brucellosis of the spine. It also aims to create awareness among all health care professionals, especially spine surgeons, regarding this rare entity. Methods: This was a retrospective study of children aged less than 15 years who were diagnosed and treated for brucellosis of the spine. Confirmed cases of brucellosis in children who had completed a full course of a triple-drug regimen as per Centers for Disease Control and Prevention (CDC) guidelines were included. Outcome analysis included both clinical and radiological measures. Clinical measures included pain, neurological status, and return to school. Resolution of the abscess and sclerosis of the involved vertebra were taken as the radiological measure. Results: A total of 5 children (4 boys and 1 girl) with an average age of 10 years, ranging from 6 to 14 years, fulfilled the inclusion criteria. The mean follow-up period was 32 months. All children presented with fever, back pain, and constitutional symptoms. Two of them had neurological deficits, and posttreatment, they improved to near normal neurological status. Only 1 child with an epidural abscess compressing the lumbar canal required surgical intervention. All the children were treated with a triple-drug regimen. Longer duration of treatment (14 months) was given for 2 children with history of relapse. All children were healed of the disease without any sequalae or relapse. Conclusions: Blood culture and standard agglutination tests are mandatory for the diagnosis of brucellosis. Children tolerated the triple-drug regimen well. Prolonged duration of treatment was required for children with relapse. Health education to all treating health care professionals and parents is of paramount importance for treatment and control of this endemic disease.

Research paper thumbnail of Treatment of chronic bilateral facet dislocation in a 6-year-old: A case report

SAGE Open Medical Case Reports, 2018

Objectives:Spine injuries seldom affect the subaxial spine in children less than 9 years of age. ... more Objectives:Spine injuries seldom affect the subaxial spine in children less than 9 years of age. We describe the management of a chronic paediatric bilateral facet dislocation.Methods:Case report and literature review. A 6-year-old boy presented 10 weeks after a motor vehicle collision with bilateral C4–C5 malunited facet dislocation. He had an incomplete spinal cord injury; right brown sequard hemiplegia, Frankel grade D.Results:Surgical management was through posterior–anterior–posterior approach without preoperative skull traction. Two years postoperatively, the child was asymptomatic, ambulating and functioning well. The injury had healed in radiographs.Conclusion:A combined approach for chronic bilateral facet dislocation applies to the paediatric age group to realign the spine.

Research paper thumbnail of The value of the use of the O-arm and Neuronavigation in the Minimally Invasive Spine Surgery Cases

Research paper thumbnail of Pediatric Upper Cervical Spine Giant Cell Tumor: Case Report

Global Spine Journal, 2014

Study Design Case report. Objective The purpose of this work is to report the case of a giant cel... more Study Design Case report. Objective The purpose of this work is to report the case of a giant cell tumor involving the second cervical vertebra in a pediatric patient. Surgical management included a combined posterior and anterior cervical approach. There has been no recurrence in 2 years of follow-up. Case Report A 13-year-old girl presented with scoliosis with incidentally lytic lesion involving the second cervical vertebra. The radiologic investigations and biopsy result indicated a giant cell tumor of the bone. A combined posterior and anterior cervical approach was performed to resect the lesion, reconstruct the spine, and restore stability. Two years of follow-up revealed no recurrence of the lesion with stable reconstruction of the spine. Results The lesion was surgically managed for excision and spinal fusion by combining a posterior occipitocervical arthrodesis with an anterior retropharyngeal cervical approach. The final histopathology result confirmed a giant cell tumor o...

Research paper thumbnail of Ultrastructural study of the microvasculature in the cerebral bed adjacent to arteriovenous malformation nidus: a proof against endovascular embolization

International Congress Series, 2004

Background: The pathology of cerebral arteriovenous malformations (AVMs) is still a matter of con... more Background: The pathology of cerebral arteriovenous malformations (AVMs) is still a matter of considerable debate. Endovascular embolization as a treatment modality for AVMs is not yet well established. Methods: The study was conducted on seven AVM cases that had been operated upon without preoperative endovascular embolization, three cases that had preoperative endovascular embolization, and two controls. All were examined using transmission electron microscopy. Results: The capillaries of the preoperatively embolized cases showed changes at the level of their lining endothelium and surrounding extracellular matrix. Conclusion: Preoperative endovascular embolization is proven to be harmful to the parenchymal capillaries in the bed of resected AVMs.

Research paper thumbnail of Cervical Dumbbell: Ganglioneuromas Causing Myelopathy in a Case of Neurofibromatosis Type-I: Case Report and Literature Review

Egyptian Spine Journal, Jul 1, 2017

Background Data: Ganglioneuromas are rare benign tumors arising from the sympathetic nervous syst... more Background Data: Ganglioneuromas are rare benign tumors arising from the sympathetic nervous system. They occasionally grow in a dumbbell fashion extending into the spinal canal extradurally. However, ganglioneuromas of the cervical spine with intradural extension or multiple locations or in association with neurofibromatosis type-I are rare. Purpose: Our aim is to describe a man with cervical compressive myelopathy at C2 level caused by dumbbell shaped intradural extramedullary ganglioneuroma and multilevel spinal lesions (ganglioneuromas) associated with neurofibromatosis type-I with genetic predisposition. Study Design: Case report and review of the literature. Patient and Method: Twenty eight year-old man with NF-I presented with acute history of progressive quadriparesis. Magnetic resonance imaging showed bilateral dumbbell masses at the C2 level compressing the spinal cord. A systemic imaging survey of the patient showed numerous asymptomatic foraminal and extraforaminal tumors at all neuroforamina of the spine. Results: Surgical decompression of the spinal cord by resections of bilateral tumors at the C2 level alleviated patient symptoms. Histopathological diagnosis was ganglioneuroma. The patient was heterozygous in the NF-I gene for a sequence variant defined as c.970T>C, and predicted to result in the amino acid substitution p.Cys324Arg. Conclusion: The case reported here is very unusual because of its type, its location as dumbbell spinal ganglioneuroma at level of 2nd cervical spine, being associated with other ganglioneuromas at other spinal levels and being associated with NF-I molecular mutation. (2017ESJ143)

Research paper thumbnail of Microvascular pathological features of immediate perinidal parenchyma in cerebral arteriovenous malformations: giant bed capillaries

Journal of Neurosurgery, May 1, 2003

The behavior of brain tissue in cases of arteriovenous malformations (AVMs) is a matter of debate... more The behavior of brain tissue in cases of arteriovenous malformations (AVMs) is a matter of debate. The authors believe that the local microvascular environment in the AVM bed shares the hemodynamic changes influencing that behavior in one way or another. The purpose of this study was to investigate the microvascular pathological features in the immediate perinidal brain tissue. This retrospective study was conducted using excised AVM specimens obtained in 35 patients, from which the authors selected 20 specimens that fulfilled the criteria for sufficient brain tissue around the excised nidus. Specimens were stained with hematoxylin and eosin, and the immediate perinidal microvascular environment was examined using light microscopy. Eighty-five percent of the AVMs studied showed the presence of huge, dilated capillaries, and 65% showed severe congestion of these capillaries. The authors have named these capillaries &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;giant bed capillaries.&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; In this study capillary bleeding was shown in AVMs, and a pericapillary space was seen around some vessels. The brain parenchyma containing AVMs with these findings proved to be significantly ischemic.

Research paper thumbnail of Phacoemulsification in the anterior chamber: preliminary results

Developments in ophthalmology, 2002

... Chamber: Preliminary Results Jorge L. Alió, Ahmad MM Shalaby, Walid H. Attia ... Page 14. Ali... more ... Chamber: Preliminary Results Jorge L. Alió, Ahmad MM Shalaby, Walid H. Attia ... Page 14. Alió/Shalaby/Attia 72 Conclusion ... References 1 Kraff MC, Sanders DR: Planned extracapsular extraction versus phacoemulsification with IOL implantation: A comparison of current series. ...

Research paper thumbnail of Spontaneous resorption of sequestrated intervertebral disc herniation

Research paper thumbnail of Role of the O-arm and Computer-assisted Navigation of Safe Screw Fixation in Children with Traumatic Rotatory Atlantoaxial Subluxation

Study Design: A retrospective analysis of 7 patients with traumatic rotatory atlanto-axial sublux... more Study Design: A retrospective analysis of 7 patients with traumatic rotatory atlanto-axial subluxation. Overview of Literature: Cases of traumatic rotatory atlantoaxial subluxation in children are difficult to be stabilized. Surgical challenges include: narrow pedicles, medial vertebral arteries, vertebral artery anomalies, fractured pedicles or lateral masses, and fixed subluxation. The use of O-arm and computer-assisted navigation are still tested as aiding tools in such operative modalities. Purpose: Report of clinical series for evaluation of the safety of use of the O-arm and computed assisted-navigation in screw fixation in children with traumatic rotatory atlantoaxial subluxation. Methods: In the present study, 7 cases of rotatory atlantoaxial traumatic subluxation were operated between December 2009 and March 2011. All patient-cases had undergone open reduction and instrumentation using atlas lateral mass and axis pedicle screws with intraoperative O-arm with computer-assisted navigation. Results: All hardware was safely placed in the planned trajectories in all the 7 cases. Intraoperative O-arm and computer assisted-navigation were useful in securing neural and vascular tissues safety with tough-bony purchases of the hardware from the first and only trial of application with sufficient reduction of the subluxation. Conclusions: Successful surgery is possible with using the intraoperative O-arm and computer-assisted navigation in safe and proper placement of difficult atlas lateral mass and axis pedicle screws for rotatory atlantoaxial subluxation in children.

Research paper thumbnail of Pediatric Upper Cervical Spine Giant Cell Tumor: Case Report

Global Spine Journal, 2014

Study Design Case report. Objective The purpose of this work is to report the case of a giant cel... more Study Design Case report. Objective The purpose of this work is to report the case of a giant cell tumor involving the second cervical vertebra in a pediatric patient. Surgical management included a combined posterior and anterior cervical approach. There has been no recurrence in 2 years of follow-up. Case Report A 13-year-old girl presented with scoliosis with incidentally lytic lesion involving the second cervical vertebra. The radiologic investigations and biopsy result indicated a giant cell tumor of the bone. A combined posterior and anterior cervical approach was performed to resect the lesion, reconstruct the spine, and restore stability. Two years of follow-up revealed no recurrence of the lesion with stable reconstruction of the spine. Results The lesion was surgically managed for excision and spinal fusion by combining a posterior occipitocervical arthrodesis with an anterior retropharyngeal cervical approach. The final histopathology result confirmed a giant cell tumor of the bone. Conclusions Giant cell tumor involving the second cervical vertebra is uncommon; this tumor can be managed surgically by using a combined posterior and anterior cervical retropharyngeal approach. The presented case was unique in terms of the tumor location, patient age, and surgical management.

Research paper thumbnail of Endoscope-Controlled Removal of Intrameatal Vestibular Schwannomas

min - Minimally Invasive Neurosurgery, 2006

The use of endoscopes for surgery of the cerebellopontine angle tumors is steadily obtaining wide... more The use of endoscopes for surgery of the cerebellopontine angle tumors is steadily obtaining widespread acceptance. The objective of the present study was a laboratory and clinical evaluation of the safety of the endoscope-controlled microneurosurgical removal of the intrameatal vestibular schwannomas through a retrosigmoid approach. The anatomical investigation was done on formalin-fixed cadaver heads and dry temporal bones. Clinical series included 33 consecutive patients (23 women and 10 men; mean age 50 +/- 15 years). A bayonet-style rigid endoscope with 70 degrees angle of view and 4 mm outer diameter was found to be optimal for observation of the internal auditory canal. Its insertion in the cerebellopontine cistern should be preferably done under control through an operating microscope. Endoscope-controlled manipulations necessitate the use of a special holder system, which provides a stable position of the device and allows bimanual manipulations by the surgeon. A thermographic evaluation did not reveal a significant increase of the local temperature due to use of the endoscope. Use of the endoscope permitted removal of the neoplasm from the most lateral part of the internal auditory canal and identification of the nerve of tumor origin. In total, 28 tumors underwent total removal, and anatomical preservation of the facial nerve was attained in 31 cases. Damage of the facial nerve by the endoscope was met once. In 8 out of 16 patients, who showed serviceable hearing before surgery, this was preserved after tumor removal. In conclusion, endoscope-controlled removal of the intrameatal vestibular schwannomas seems to be a technically feasible, effective and safe procedure. Nevertheless, good equipment and special training are absolutely necessary for attainment of optimal results.

Research paper thumbnail of Microvascular pathological features of immediate perinidal parenchyma in cerebral arteriovenous malformations: giant bed capillaries

Journal of Neurosurgery, 2003

The behavior of brain tissue in cases of arteriovenous malformations (AVMs) is a matter of debate... more The behavior of brain tissue in cases of arteriovenous malformations (AVMs) is a matter of debate. The authors believe that the local microvascular environment in the AVM bed shares the hemodynamic changes influencing that behavior in one way or another. The purpose of this study was to investigate the microvascular pathological features in the immediate perinidal brain tissue. This retrospective study was conducted using excised AVM specimens obtained in 35 patients, from which the authors selected 20 specimens that fulfilled the criteria for sufficient brain tissue around the excised nidus. Specimens were stained with hematoxylin and eosin, and the immediate perinidal microvascular environment was examined using light microscopy. Eighty-five percent of the AVMs studied showed the presence of huge, dilated capillaries, and 65% showed severe congestion of these capillaries. The authors have named these capillaries &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;giant bed capillaries.&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; In this study capillary bleeding was shown in AVMs, and a pericapillary space was seen around some vessels. The brain parenchyma containing AVMs with these findings proved to be significantly ischemic.

Research paper thumbnail of Laser in situ keratomileusis for undercorrection and overcorrection after radial keratotomy

Journal of Cataract & Refractive Surgery, 2001

To evaluate laser in situ keratomileusis (LASIK) in the management of overcorrection and undercor... more To evaluate laser in situ keratomileusis (LASIK) in the management of overcorrection and undercorrection after radial keratotomy (RK). Instituto Oftalmológico de Alicante, Alicante, Spain. This prospective study comprised 20 eyes of 13 patients. The eyes were divided into 2 groups: 11 eyes that were overcorrected after RK and 9 eyes that were undercorrected after RK. Both groups were treated with LASIK after a mean interval of 22 months +/- 8.4 (SD) (range 12 to 45 months). The follow-up was 6 months. Six months after LASIK, there was a significant decrease in the spherical equivalent in both groups. Ninety-one percent of eyes in the overcorrected group and 89% in the undercorrected group were within +/-1.0 diopter of the intended correction. There was a significant improvement in the uncorrected visual acuity in both groups. In the overcorrected group, 91% showed no change or improvement in their best corrected visual acuity; in the undercorrected group, 89% showed no change or improvement. Laser in situ keratomileusis was relatively safe in treating both overcorrection and undercorrection after RK. With proper intraoperative precautions, LASIK can effectively treat the residual refractive defects after RK.

Research paper thumbnail of Phacoemulsification in the anterior chamber

Journal of Cataract & Refractive Surgery, 2002

To evaluate anterior chamber phacoemulsification as an alternative to an endocapsular procedure. ... more To evaluate anterior chamber phacoemulsification as an alternative to an endocapsular procedure. Instituto Oftalmológico de Alicante, Alicante, Spain. In this prospective randomized masked clinical trial, 60 eyes of 30 patients had cataract extraction by phacoemulsification. A conventional stop-and-chop technique was used in 30 eyes; the other 30 had surgery by the phaco-out technique in which the nucleus was prolapsed into the anterior chamber using extensive hydrodissection. Copious sodium hyaluronate 3.0%-chondroitin sulfate 4.0% (Viscoat) and hydroxypropyl methylcellulose were used to protect the cornea and iris. The phaco time and power, postoperative inflammation, corneal edema (clinically and by pachymetry), and endothelial cell count between groups preoperatively and postoperatively were compared. All patients completed a 3-month follow-up. Postoperative examinations were at 3 days, 2 weeks, and 1 and 3 months. The mean nuclear hardness was 2.67 +/- 0.61 (SD) in the stop-and-chop group and 2.65 +/- 0.71 in the phaco-out group. The power-to-time ratio was 18.47 and 18.80, respectively. The mean endothelial cell loss was 11.18% +/- 4.24% in the stop-and-chop group and 11.20% +/- 5.60% in the phaco-out group. There were no significant differences between groups in any parameter (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;.05, independent-sample t test). Phacoemulsification in the anterior chamber was as safe as endocapsular phacoemulsification using a stop-and-chop technique. This technique is fast and easier to learn than endocapsular phacoemulsification.

Research paper thumbnail of Brown Tumor of the Cervical Spines: A Case Report with Literature Review

Asian Spine Journal, 2015

Research paper thumbnail of Cases

Neurosurgery Rounds: Questions and Answers, 2011

Research paper thumbnail of Accuracy of Percutaneous Pedicle Screw Insertion Technique with Conventional Dual Fluoroscopy Units and a Retrospective Comparative Study Based on Surgeon Experience

Global Spine Journal, 2016

Study Design Retrospective comparative study. Objective To evaluate the accuracy of percutaneous ... more Study Design Retrospective comparative study. Objective To evaluate the accuracy of percutaneous pedicle screw (PPS) placement and intraoperative imaging time using dual fluoroscopy units and their differences between surgeons with more versus less experience. Methods One hundred sixty-one patients who underwent lumbar fusion surgery were divided into two groups, A ( n = 74) and B ( n = 87), based on the performing surgeon's experience. The accuracy of PPS placement and radiation time for PPS insertion were compared. PPSs were inserted with classic technique under the assistance of dual fluoroscopy units placed in two planes. The breach definition of PPS misplacement was based on postoperative computed tomography (grade I: no breach; grade II: <2 mm; grade III: ≤2 to <4 mm). Results Of 658 PPSs, only 21 screws were misplaced. The breach rates of groups A and B were 3.3% (grade II: 3.4%, grade III: 0%) and 3.1% (grade II: 2.6%, grade III: 0.6%; p = 0.91). One patient in gra...

Research paper thumbnail of Treatment of chronic bilateral facet dislocation in a 6-year-old: A case report

SAGE open medical case reports, 2018

Objectives: Spine injuries seldom affect the subaxial spine in children less than 9 years of age.... more Objectives: Spine injuries seldom affect the subaxial spine in children less than 9 years of age. We describe the management of a chronic paediatric bilateral facet dislocation. Methods: Case report and literature review. A 6-year-old boy presented 10 weeks after a motor vehicle collision with bilateral C4-C5 malunited facet dislocation. He had an incomplete spinal cord injury; right brown sequard hemiplegia, Frankel grade D. Results: Surgical management was through posterior-anterior-posterior approach without preoperative skull traction. Two years postoperatively, the child was asymptomatic, ambulating and functioning well. The injury had healed in radiographs. Conclusion: A combined approach for chronic bilateral facet dislocation applies to the paediatric age group to realign the spine.

Research paper thumbnail of Brucellosis of the spine – A global public health problem - An analysis of 37 patients from a ‘high risk’ region

Journal of clinical orthopaedics and trauma, Mar 1, 2023

Research paper thumbnail of Brucellosis of the Spine in Children—An Analysis of 5 Children From an Endemic Setting

International Journal of Spine Surgery, 2021

Background: Brucellosis of the spine is quite common among adults in endemic regions. The inciden... more Background: Brucellosis of the spine is quite common among adults in endemic regions. The incidence of brucellosis of the spine affecting children is very rare. This article describes the clinical characteristics, diagnosis, management and outcome of children with brucellosis of the spine. It also aims to create awareness among all health care professionals, especially spine surgeons, regarding this rare entity. Methods: This was a retrospective study of children aged less than 15 years who were diagnosed and treated for brucellosis of the spine. Confirmed cases of brucellosis in children who had completed a full course of a triple-drug regimen as per Centers for Disease Control and Prevention (CDC) guidelines were included. Outcome analysis included both clinical and radiological measures. Clinical measures included pain, neurological status, and return to school. Resolution of the abscess and sclerosis of the involved vertebra were taken as the radiological measure. Results: A total of 5 children (4 boys and 1 girl) with an average age of 10 years, ranging from 6 to 14 years, fulfilled the inclusion criteria. The mean follow-up period was 32 months. All children presented with fever, back pain, and constitutional symptoms. Two of them had neurological deficits, and posttreatment, they improved to near normal neurological status. Only 1 child with an epidural abscess compressing the lumbar canal required surgical intervention. All the children were treated with a triple-drug regimen. Longer duration of treatment (14 months) was given for 2 children with history of relapse. All children were healed of the disease without any sequalae or relapse. Conclusions: Blood culture and standard agglutination tests are mandatory for the diagnosis of brucellosis. Children tolerated the triple-drug regimen well. Prolonged duration of treatment was required for children with relapse. Health education to all treating health care professionals and parents is of paramount importance for treatment and control of this endemic disease.

Research paper thumbnail of Treatment of chronic bilateral facet dislocation in a 6-year-old: A case report

SAGE Open Medical Case Reports, 2018

Objectives:Spine injuries seldom affect the subaxial spine in children less than 9 years of age. ... more Objectives:Spine injuries seldom affect the subaxial spine in children less than 9 years of age. We describe the management of a chronic paediatric bilateral facet dislocation.Methods:Case report and literature review. A 6-year-old boy presented 10 weeks after a motor vehicle collision with bilateral C4–C5 malunited facet dislocation. He had an incomplete spinal cord injury; right brown sequard hemiplegia, Frankel grade D.Results:Surgical management was through posterior–anterior–posterior approach without preoperative skull traction. Two years postoperatively, the child was asymptomatic, ambulating and functioning well. The injury had healed in radiographs.Conclusion:A combined approach for chronic bilateral facet dislocation applies to the paediatric age group to realign the spine.

Research paper thumbnail of The value of the use of the O-arm and Neuronavigation in the Minimally Invasive Spine Surgery Cases

Research paper thumbnail of Pediatric Upper Cervical Spine Giant Cell Tumor: Case Report

Global Spine Journal, 2014

Study Design Case report. Objective The purpose of this work is to report the case of a giant cel... more Study Design Case report. Objective The purpose of this work is to report the case of a giant cell tumor involving the second cervical vertebra in a pediatric patient. Surgical management included a combined posterior and anterior cervical approach. There has been no recurrence in 2 years of follow-up. Case Report A 13-year-old girl presented with scoliosis with incidentally lytic lesion involving the second cervical vertebra. The radiologic investigations and biopsy result indicated a giant cell tumor of the bone. A combined posterior and anterior cervical approach was performed to resect the lesion, reconstruct the spine, and restore stability. Two years of follow-up revealed no recurrence of the lesion with stable reconstruction of the spine. Results The lesion was surgically managed for excision and spinal fusion by combining a posterior occipitocervical arthrodesis with an anterior retropharyngeal cervical approach. The final histopathology result confirmed a giant cell tumor o...

Research paper thumbnail of Ultrastructural study of the microvasculature in the cerebral bed adjacent to arteriovenous malformation nidus: a proof against endovascular embolization

International Congress Series, 2004

Background: The pathology of cerebral arteriovenous malformations (AVMs) is still a matter of con... more Background: The pathology of cerebral arteriovenous malformations (AVMs) is still a matter of considerable debate. Endovascular embolization as a treatment modality for AVMs is not yet well established. Methods: The study was conducted on seven AVM cases that had been operated upon without preoperative endovascular embolization, three cases that had preoperative endovascular embolization, and two controls. All were examined using transmission electron microscopy. Results: The capillaries of the preoperatively embolized cases showed changes at the level of their lining endothelium and surrounding extracellular matrix. Conclusion: Preoperative endovascular embolization is proven to be harmful to the parenchymal capillaries in the bed of resected AVMs.

Research paper thumbnail of Cervical Dumbbell: Ganglioneuromas Causing Myelopathy in a Case of Neurofibromatosis Type-I: Case Report and Literature Review

Egyptian Spine Journal, Jul 1, 2017

Background Data: Ganglioneuromas are rare benign tumors arising from the sympathetic nervous syst... more Background Data: Ganglioneuromas are rare benign tumors arising from the sympathetic nervous system. They occasionally grow in a dumbbell fashion extending into the spinal canal extradurally. However, ganglioneuromas of the cervical spine with intradural extension or multiple locations or in association with neurofibromatosis type-I are rare. Purpose: Our aim is to describe a man with cervical compressive myelopathy at C2 level caused by dumbbell shaped intradural extramedullary ganglioneuroma and multilevel spinal lesions (ganglioneuromas) associated with neurofibromatosis type-I with genetic predisposition. Study Design: Case report and review of the literature. Patient and Method: Twenty eight year-old man with NF-I presented with acute history of progressive quadriparesis. Magnetic resonance imaging showed bilateral dumbbell masses at the C2 level compressing the spinal cord. A systemic imaging survey of the patient showed numerous asymptomatic foraminal and extraforaminal tumors at all neuroforamina of the spine. Results: Surgical decompression of the spinal cord by resections of bilateral tumors at the C2 level alleviated patient symptoms. Histopathological diagnosis was ganglioneuroma. The patient was heterozygous in the NF-I gene for a sequence variant defined as c.970T>C, and predicted to result in the amino acid substitution p.Cys324Arg. Conclusion: The case reported here is very unusual because of its type, its location as dumbbell spinal ganglioneuroma at level of 2nd cervical spine, being associated with other ganglioneuromas at other spinal levels and being associated with NF-I molecular mutation. (2017ESJ143)

Research paper thumbnail of Microvascular pathological features of immediate perinidal parenchyma in cerebral arteriovenous malformations: giant bed capillaries

Journal of Neurosurgery, May 1, 2003

The behavior of brain tissue in cases of arteriovenous malformations (AVMs) is a matter of debate... more The behavior of brain tissue in cases of arteriovenous malformations (AVMs) is a matter of debate. The authors believe that the local microvascular environment in the AVM bed shares the hemodynamic changes influencing that behavior in one way or another. The purpose of this study was to investigate the microvascular pathological features in the immediate perinidal brain tissue. This retrospective study was conducted using excised AVM specimens obtained in 35 patients, from which the authors selected 20 specimens that fulfilled the criteria for sufficient brain tissue around the excised nidus. Specimens were stained with hematoxylin and eosin, and the immediate perinidal microvascular environment was examined using light microscopy. Eighty-five percent of the AVMs studied showed the presence of huge, dilated capillaries, and 65% showed severe congestion of these capillaries. The authors have named these capillaries &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;giant bed capillaries.&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; In this study capillary bleeding was shown in AVMs, and a pericapillary space was seen around some vessels. The brain parenchyma containing AVMs with these findings proved to be significantly ischemic.

Research paper thumbnail of Phacoemulsification in the anterior chamber: preliminary results

Developments in ophthalmology, 2002

... Chamber: Preliminary Results Jorge L. Alió, Ahmad MM Shalaby, Walid H. Attia ... Page 14. Ali... more ... Chamber: Preliminary Results Jorge L. Alió, Ahmad MM Shalaby, Walid H. Attia ... Page 14. Alió/Shalaby/Attia 72 Conclusion ... References 1 Kraff MC, Sanders DR: Planned extracapsular extraction versus phacoemulsification with IOL implantation: A comparison of current series. ...

Research paper thumbnail of Spontaneous resorption of sequestrated intervertebral disc herniation

Research paper thumbnail of Role of the O-arm and Computer-assisted Navigation of Safe Screw Fixation in Children with Traumatic Rotatory Atlantoaxial Subluxation

Study Design: A retrospective analysis of 7 patients with traumatic rotatory atlanto-axial sublux... more Study Design: A retrospective analysis of 7 patients with traumatic rotatory atlanto-axial subluxation. Overview of Literature: Cases of traumatic rotatory atlantoaxial subluxation in children are difficult to be stabilized. Surgical challenges include: narrow pedicles, medial vertebral arteries, vertebral artery anomalies, fractured pedicles or lateral masses, and fixed subluxation. The use of O-arm and computer-assisted navigation are still tested as aiding tools in such operative modalities. Purpose: Report of clinical series for evaluation of the safety of use of the O-arm and computed assisted-navigation in screw fixation in children with traumatic rotatory atlantoaxial subluxation. Methods: In the present study, 7 cases of rotatory atlantoaxial traumatic subluxation were operated between December 2009 and March 2011. All patient-cases had undergone open reduction and instrumentation using atlas lateral mass and axis pedicle screws with intraoperative O-arm with computer-assisted navigation. Results: All hardware was safely placed in the planned trajectories in all the 7 cases. Intraoperative O-arm and computer assisted-navigation were useful in securing neural and vascular tissues safety with tough-bony purchases of the hardware from the first and only trial of application with sufficient reduction of the subluxation. Conclusions: Successful surgery is possible with using the intraoperative O-arm and computer-assisted navigation in safe and proper placement of difficult atlas lateral mass and axis pedicle screws for rotatory atlantoaxial subluxation in children.

Research paper thumbnail of Pediatric Upper Cervical Spine Giant Cell Tumor: Case Report

Global Spine Journal, 2014

Study Design Case report. Objective The purpose of this work is to report the case of a giant cel... more Study Design Case report. Objective The purpose of this work is to report the case of a giant cell tumor involving the second cervical vertebra in a pediatric patient. Surgical management included a combined posterior and anterior cervical approach. There has been no recurrence in 2 years of follow-up. Case Report A 13-year-old girl presented with scoliosis with incidentally lytic lesion involving the second cervical vertebra. The radiologic investigations and biopsy result indicated a giant cell tumor of the bone. A combined posterior and anterior cervical approach was performed to resect the lesion, reconstruct the spine, and restore stability. Two years of follow-up revealed no recurrence of the lesion with stable reconstruction of the spine. Results The lesion was surgically managed for excision and spinal fusion by combining a posterior occipitocervical arthrodesis with an anterior retropharyngeal cervical approach. The final histopathology result confirmed a giant cell tumor of the bone. Conclusions Giant cell tumor involving the second cervical vertebra is uncommon; this tumor can be managed surgically by using a combined posterior and anterior cervical retropharyngeal approach. The presented case was unique in terms of the tumor location, patient age, and surgical management.

Research paper thumbnail of Endoscope-Controlled Removal of Intrameatal Vestibular Schwannomas

min - Minimally Invasive Neurosurgery, 2006

The use of endoscopes for surgery of the cerebellopontine angle tumors is steadily obtaining wide... more The use of endoscopes for surgery of the cerebellopontine angle tumors is steadily obtaining widespread acceptance. The objective of the present study was a laboratory and clinical evaluation of the safety of the endoscope-controlled microneurosurgical removal of the intrameatal vestibular schwannomas through a retrosigmoid approach. The anatomical investigation was done on formalin-fixed cadaver heads and dry temporal bones. Clinical series included 33 consecutive patients (23 women and 10 men; mean age 50 +/- 15 years). A bayonet-style rigid endoscope with 70 degrees angle of view and 4 mm outer diameter was found to be optimal for observation of the internal auditory canal. Its insertion in the cerebellopontine cistern should be preferably done under control through an operating microscope. Endoscope-controlled manipulations necessitate the use of a special holder system, which provides a stable position of the device and allows bimanual manipulations by the surgeon. A thermographic evaluation did not reveal a significant increase of the local temperature due to use of the endoscope. Use of the endoscope permitted removal of the neoplasm from the most lateral part of the internal auditory canal and identification of the nerve of tumor origin. In total, 28 tumors underwent total removal, and anatomical preservation of the facial nerve was attained in 31 cases. Damage of the facial nerve by the endoscope was met once. In 8 out of 16 patients, who showed serviceable hearing before surgery, this was preserved after tumor removal. In conclusion, endoscope-controlled removal of the intrameatal vestibular schwannomas seems to be a technically feasible, effective and safe procedure. Nevertheless, good equipment and special training are absolutely necessary for attainment of optimal results.

Research paper thumbnail of Microvascular pathological features of immediate perinidal parenchyma in cerebral arteriovenous malformations: giant bed capillaries

Journal of Neurosurgery, 2003

The behavior of brain tissue in cases of arteriovenous malformations (AVMs) is a matter of debate... more The behavior of brain tissue in cases of arteriovenous malformations (AVMs) is a matter of debate. The authors believe that the local microvascular environment in the AVM bed shares the hemodynamic changes influencing that behavior in one way or another. The purpose of this study was to investigate the microvascular pathological features in the immediate perinidal brain tissue. This retrospective study was conducted using excised AVM specimens obtained in 35 patients, from which the authors selected 20 specimens that fulfilled the criteria for sufficient brain tissue around the excised nidus. Specimens were stained with hematoxylin and eosin, and the immediate perinidal microvascular environment was examined using light microscopy. Eighty-five percent of the AVMs studied showed the presence of huge, dilated capillaries, and 65% showed severe congestion of these capillaries. The authors have named these capillaries &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;giant bed capillaries.&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; In this study capillary bleeding was shown in AVMs, and a pericapillary space was seen around some vessels. The brain parenchyma containing AVMs with these findings proved to be significantly ischemic.

Research paper thumbnail of Laser in situ keratomileusis for undercorrection and overcorrection after radial keratotomy

Journal of Cataract & Refractive Surgery, 2001

To evaluate laser in situ keratomileusis (LASIK) in the management of overcorrection and undercor... more To evaluate laser in situ keratomileusis (LASIK) in the management of overcorrection and undercorrection after radial keratotomy (RK). Instituto Oftalmológico de Alicante, Alicante, Spain. This prospective study comprised 20 eyes of 13 patients. The eyes were divided into 2 groups: 11 eyes that were overcorrected after RK and 9 eyes that were undercorrected after RK. Both groups were treated with LASIK after a mean interval of 22 months +/- 8.4 (SD) (range 12 to 45 months). The follow-up was 6 months. Six months after LASIK, there was a significant decrease in the spherical equivalent in both groups. Ninety-one percent of eyes in the overcorrected group and 89% in the undercorrected group were within +/-1.0 diopter of the intended correction. There was a significant improvement in the uncorrected visual acuity in both groups. In the overcorrected group, 91% showed no change or improvement in their best corrected visual acuity; in the undercorrected group, 89% showed no change or improvement. Laser in situ keratomileusis was relatively safe in treating both overcorrection and undercorrection after RK. With proper intraoperative precautions, LASIK can effectively treat the residual refractive defects after RK.

Research paper thumbnail of Phacoemulsification in the anterior chamber

Journal of Cataract & Refractive Surgery, 2002

To evaluate anterior chamber phacoemulsification as an alternative to an endocapsular procedure. ... more To evaluate anterior chamber phacoemulsification as an alternative to an endocapsular procedure. Instituto Oftalmológico de Alicante, Alicante, Spain. In this prospective randomized masked clinical trial, 60 eyes of 30 patients had cataract extraction by phacoemulsification. A conventional stop-and-chop technique was used in 30 eyes; the other 30 had surgery by the phaco-out technique in which the nucleus was prolapsed into the anterior chamber using extensive hydrodissection. Copious sodium hyaluronate 3.0%-chondroitin sulfate 4.0% (Viscoat) and hydroxypropyl methylcellulose were used to protect the cornea and iris. The phaco time and power, postoperative inflammation, corneal edema (clinically and by pachymetry), and endothelial cell count between groups preoperatively and postoperatively were compared. All patients completed a 3-month follow-up. Postoperative examinations were at 3 days, 2 weeks, and 1 and 3 months. The mean nuclear hardness was 2.67 +/- 0.61 (SD) in the stop-and-chop group and 2.65 +/- 0.71 in the phaco-out group. The power-to-time ratio was 18.47 and 18.80, respectively. The mean endothelial cell loss was 11.18% +/- 4.24% in the stop-and-chop group and 11.20% +/- 5.60% in the phaco-out group. There were no significant differences between groups in any parameter (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;.05, independent-sample t test). Phacoemulsification in the anterior chamber was as safe as endocapsular phacoemulsification using a stop-and-chop technique. This technique is fast and easier to learn than endocapsular phacoemulsification.