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Papers by Mostafa Aboelkhir

Research paper thumbnail of Spheno-Orbital Enplaque Meningioma; Surgical strategy and Proptosis result

Al-Azhar International Medical Journal (Print), Dec 31, 2022

Background: Spheno-orbital enplaque meningioma (SOEMs) are complex lesions that primarily origina... more Background: Spheno-orbital enplaque meningioma (SOEMs) are complex lesions that primarily originate in the sphenoid wing with extensive hyperostosis and may involve the orbit and cavernous sinus, making a gross total resection difficult and posing a high risk of postsurgical morbidity and recurrence. Aim of the work: To assess outcome and CSF leakage incidence according to type of dural graft in CM-I patients. Patients and methods: a series of 13 consecutive patients with SOEM presented by proptosis and hyperostosis who underwent surgical excision by frontotemporal craniotomy, clinical, radiological, surgical technique and follow up was reviewed and analyzed. Results: In this series of 13 consecutive patients, 11 were women and 2 were men. The age range was from 35-63 years with a mean of 46.3 years. Tumors were located on the right side in 9 patients (69%) and the left side in 4 patients (31%). Cavernous sinus (CS) and superior orbital fissure (SOF) invasion in 4 cases (31%). Gross total excision grades I and II were obtained in 6 cases (46%), near total excision grades III in 3 cases (23%), and partial excision grade IV in 4 cases (31%). 11 cases (85%) show improvement of proptosis (7 patients, 54% have a complete resolution of proptosis and 4 cases, 31% have partial resolution of proptosis) and 2 cases show no improvement of proptosis after a long followup period. Conclusion: The decision for each case of Spheno-orbital enplaque meningioma should be individualized depending on the extension of the lesion to the surrounding structures. Extension to the CS and SOF should be considered the surgical limit for excision. Early presentation and surgery enable gross total resection, rapid improvement, and more stable follow-up.

Research paper thumbnail of Outcome of Posterior Fossa Decompression with Duraplasty by Different Types of Graft in Patients with Chiari Malformation Type I

Al-Azhar International Medical Journal

Background: Chiari malformation type I (CM-I) is treated surgically by suboccipital craniectomy w... more Background: Chiari malformation type I (CM-I) is treated surgically by suboccipital craniectomy with or without duraplasty. Duraplasty may be performed using a variety of dural grafts, including autologous pericranium, allografts, xenografts, and synthetic substitutes. Aim of the work: To assess outcome and CSF leakage incidence according to type of dural graft in CM-I patients. Patients and methods: This study included twenty-eight patients with Chiari malformation type I who underwent posterior fossa decompression with duroplasty were randomly assigned into two equal groups: Group A (N=14): patients were treated with a dural substitute Engineered collagen matrix grafts (DuraGen). Group-B (N=14): patients were treated with free tissue fascia lata graft. All patients had neurological assessment and basal laboratory investigations. Magnetic resonance imaging (MRI) of the brain and craniocervical junction as well as computed tomography (CT) of the brain were done preoperatively.. Results: Regarding clinical outcome, fascia lata group showed higher significant excellent rate (92.9%) than DuraGen group (57.1%) (p=0.032). Also, one patient showed good outcome and none showed poor outcome in patients with fascia lata graft while there were four patients with good outcome, two with poor outcome in DuraGen graft patients without significance. Considering postoperative complications, only one patient (7.1%) in fascia lata group showed tight bandage while DuraGen group showed eight patients (57.1%) with CSF leakage (p=0.001), four patients (28.6%) needed reoperations (p=0.033), two cases (14.3%) with Aseptic meningitis and ten cases (71.4%) with tight bandage (p < 0.001). Conclusion: CM-I decompression surgery with duraplasty by fascia lata graft has a better outcome and lower significant rate of CSF leakage and other postoperative complications than engineered collagen graft (DuraGen).

Research paper thumbnail of Free Hand One Stage Correction of Kyphoscoliosis

Open Journal of Modern Neurosurgery, 2022

Background: Scoliosis is a complex musculoskeletal torsional deformity of spine that includes: La... more Background: Scoliosis is a complex musculoskeletal torsional deformity of spine that includes: Lateral curvature in the anterior-posterior plane with a Cobb angle greater than 10 degrees, Angulation in the sagittal plane, or Rotation in the transverse plane. Scoliosis classified into neuromuscular, idiopathic, or congenital. Radiological evaluation is done by plain radiography, computed tomography (CT), and magnetic resonance (MR). We aimed to evaluate patients with idiopathic kyphoscoliosis who underwent a freehand posterior approach for scoliosis correction through transpedicular screws fixation. Setting: Al-Azhar University Hospitals. Subjects and Methods: Study was performed on 12 patients with idiopathic kyphoscoliosis who underwent a freehand posterior approach for scoliosis correction through transpedicular screws fixation in Al-Azhar University Hospitals between 2015 to 2018 & follow up for one year. Results: Early outcome showed improved Cobb's angle and coronal balance significantly after surgery. Correction is 95% in 2 cases (17%), 80% correction in 8 cases (66%), 60% correction in 2 cases (17%). 2 cases have CSF leakage which improved with conservative treatment. Late follow-up shows improvement of patient deformity and cosmetic appearance to the degree of patient satisfaction occur in 7 cases (58%) associated with high SRS-30 total scores. However, assessment of the pain in comparison to preoperative assessment show improvement of pain in 4 cases (33%), persistent in 4 cases (33%), appear in 4 cases (33%). Conclusion: Freehand onestage correction management of idiopathic kyphoscoliosis through the posterior approach is a safe and effective for near-total correction of deformity with a good outcome with minimal complications.

Research paper thumbnail of Long-segment Fixation with Posterolateral Fusion Versus Short-segment Fixation with Interbody Fusion for Management of High-Grade Lumbar Spondylolisthesis

Al-Azhar International Medical Journal (Print), Oct 23, 2022

Background: Lumbar spondylolisthesis frequently causes a sagittal imbalance of the spine because ... more Background: Lumbar spondylolisthesis frequently causes a sagittal imbalance of the spine because it frequently co-occurs with other abnormalities, including forward slip and kyphosis. Spinopelvic sagittal balance is critical in spondylolisthesis assessment and treatment. The traditional fixation placement method, referred to as "short segment fixation," involves placing pedicle screws into the lower and slipping vertebral bodies. The upper vertebrae received additional pedicle screws, resulting in a long segment fixation.. Aim of the work: To to assess the results of long-segment with posterolateral fusion fixation (Long-segment PLF) versus short-segment fixation with interbody fusion (Short-segment PLIF) for the treatment of high-grade lumbar spondylolisthesis. Patients and methods: Study design: It was designed as a prospective, randomized comparison study. Setting: Al Azhar university hospitals. Subjects: According to the used surgical technique, we recruited 60 high-grade lumbar spondylolisthesis patients into 2 independent groups: the long-segment PLF group, including 30 patients, and the short-segment PLIF group, including 30 patients. Methods: Each patient underwent thorough history-taking, neurological testing, and a VAS for back and leg pain. Pre-operative radiological assessment included (X-rays and MRI) and assessment of the Japanese Orthopedic Association score (JOA score). Posterior decompression with insitu posterior transpedicular screw fixation and posterolateral fusion by long segment [long-segment] fixation; and posterior decompression, reduction, and transpedicular screw fixation [short segment] with interbody fusion were the surgical techniques used. Post-operative outcome measures include VAS scale back and leg pain, post-operative JOA score, complications rate, along with patient satisfaction outcome.. Results: The study population's average age was (47.1 ± 11.2) years, with 63.3 % of females and 36.7 % of males. We found a highly significant decline in VAS ratings (back and leg pain) and a highly significant increase in JOA score in the short and long-segment PLF groups (p < 0.01 respectively). A study comparing the two groups discovered that the long-segment PLF group experienced a significantly lower rate of complications compared to the short-segment PLIF group (p < 0.05), but there have been no significant differences in postsurgical outcome (patient satisfaction) (p > 0.05). Conclusion: To conclude, both short and long-segment PLF operation techniques were proven to be equally effective regarding improvement of primary clinical outcomes (e.g., success and good satisfaction rates and VAS values for back and leg pain and JOA scores), but the complications rate was greater in the shortsegment PLIF patient group.

Research paper thumbnail of Spheno-Orbital Enplaque Meningioma; Surgical strategy and Proptosis result

Al-Azhar International Medical Journal (Print), Dec 31, 2022

Background: Spheno-orbital enplaque meningioma (SOEMs) are complex lesions that primarily origina... more Background: Spheno-orbital enplaque meningioma (SOEMs) are complex lesions that primarily originate in the sphenoid wing with extensive hyperostosis and may involve the orbit and cavernous sinus, making a gross total resection difficult and posing a high risk of postsurgical morbidity and recurrence. Aim of the work: To assess outcome and CSF leakage incidence according to type of dural graft in CM-I patients. Patients and methods: a series of 13 consecutive patients with SOEM presented by proptosis and hyperostosis who underwent surgical excision by frontotemporal craniotomy, clinical, radiological, surgical technique and follow up was reviewed and analyzed. Results: In this series of 13 consecutive patients, 11 were women and 2 were men. The age range was from 35-63 years with a mean of 46.3 years. Tumors were located on the right side in 9 patients (69%) and the left side in 4 patients (31%). Cavernous sinus (CS) and superior orbital fissure (SOF) invasion in 4 cases (31%). Gross total excision grades I and II were obtained in 6 cases (46%), near total excision grades III in 3 cases (23%), and partial excision grade IV in 4 cases (31%). 11 cases (85%) show improvement of proptosis (7 patients, 54% have a complete resolution of proptosis and 4 cases, 31% have partial resolution of proptosis) and 2 cases show no improvement of proptosis after a long followup period. Conclusion: The decision for each case of Spheno-orbital enplaque meningioma should be individualized depending on the extension of the lesion to the surrounding structures. Extension to the CS and SOF should be considered the surgical limit for excision. Early presentation and surgery enable gross total resection, rapid improvement, and more stable follow-up.

Research paper thumbnail of Outcome of Posterior Fossa Decompression with Duraplasty by Different Types of Graft in Patients with Chiari Malformation Type I

Al-Azhar International Medical Journal

Background: Chiari malformation type I (CM-I) is treated surgically by suboccipital craniectomy w... more Background: Chiari malformation type I (CM-I) is treated surgically by suboccipital craniectomy with or without duraplasty. Duraplasty may be performed using a variety of dural grafts, including autologous pericranium, allografts, xenografts, and synthetic substitutes. Aim of the work: To assess outcome and CSF leakage incidence according to type of dural graft in CM-I patients. Patients and methods: This study included twenty-eight patients with Chiari malformation type I who underwent posterior fossa decompression with duroplasty were randomly assigned into two equal groups: Group A (N=14): patients were treated with a dural substitute Engineered collagen matrix grafts (DuraGen). Group-B (N=14): patients were treated with free tissue fascia lata graft. All patients had neurological assessment and basal laboratory investigations. Magnetic resonance imaging (MRI) of the brain and craniocervical junction as well as computed tomography (CT) of the brain were done preoperatively.. Results: Regarding clinical outcome, fascia lata group showed higher significant excellent rate (92.9%) than DuraGen group (57.1%) (p=0.032). Also, one patient showed good outcome and none showed poor outcome in patients with fascia lata graft while there were four patients with good outcome, two with poor outcome in DuraGen graft patients without significance. Considering postoperative complications, only one patient (7.1%) in fascia lata group showed tight bandage while DuraGen group showed eight patients (57.1%) with CSF leakage (p=0.001), four patients (28.6%) needed reoperations (p=0.033), two cases (14.3%) with Aseptic meningitis and ten cases (71.4%) with tight bandage (p < 0.001). Conclusion: CM-I decompression surgery with duraplasty by fascia lata graft has a better outcome and lower significant rate of CSF leakage and other postoperative complications than engineered collagen graft (DuraGen).

Research paper thumbnail of Free Hand One Stage Correction of Kyphoscoliosis

Open Journal of Modern Neurosurgery, 2022

Background: Scoliosis is a complex musculoskeletal torsional deformity of spine that includes: La... more Background: Scoliosis is a complex musculoskeletal torsional deformity of spine that includes: Lateral curvature in the anterior-posterior plane with a Cobb angle greater than 10 degrees, Angulation in the sagittal plane, or Rotation in the transverse plane. Scoliosis classified into neuromuscular, idiopathic, or congenital. Radiological evaluation is done by plain radiography, computed tomography (CT), and magnetic resonance (MR). We aimed to evaluate patients with idiopathic kyphoscoliosis who underwent a freehand posterior approach for scoliosis correction through transpedicular screws fixation. Setting: Al-Azhar University Hospitals. Subjects and Methods: Study was performed on 12 patients with idiopathic kyphoscoliosis who underwent a freehand posterior approach for scoliosis correction through transpedicular screws fixation in Al-Azhar University Hospitals between 2015 to 2018 & follow up for one year. Results: Early outcome showed improved Cobb's angle and coronal balance significantly after surgery. Correction is 95% in 2 cases (17%), 80% correction in 8 cases (66%), 60% correction in 2 cases (17%). 2 cases have CSF leakage which improved with conservative treatment. Late follow-up shows improvement of patient deformity and cosmetic appearance to the degree of patient satisfaction occur in 7 cases (58%) associated with high SRS-30 total scores. However, assessment of the pain in comparison to preoperative assessment show improvement of pain in 4 cases (33%), persistent in 4 cases (33%), appear in 4 cases (33%). Conclusion: Freehand onestage correction management of idiopathic kyphoscoliosis through the posterior approach is a safe and effective for near-total correction of deformity with a good outcome with minimal complications.

Research paper thumbnail of Long-segment Fixation with Posterolateral Fusion Versus Short-segment Fixation with Interbody Fusion for Management of High-Grade Lumbar Spondylolisthesis

Al-Azhar International Medical Journal (Print), Oct 23, 2022

Background: Lumbar spondylolisthesis frequently causes a sagittal imbalance of the spine because ... more Background: Lumbar spondylolisthesis frequently causes a sagittal imbalance of the spine because it frequently co-occurs with other abnormalities, including forward slip and kyphosis. Spinopelvic sagittal balance is critical in spondylolisthesis assessment and treatment. The traditional fixation placement method, referred to as "short segment fixation," involves placing pedicle screws into the lower and slipping vertebral bodies. The upper vertebrae received additional pedicle screws, resulting in a long segment fixation.. Aim of the work: To to assess the results of long-segment with posterolateral fusion fixation (Long-segment PLF) versus short-segment fixation with interbody fusion (Short-segment PLIF) for the treatment of high-grade lumbar spondylolisthesis. Patients and methods: Study design: It was designed as a prospective, randomized comparison study. Setting: Al Azhar university hospitals. Subjects: According to the used surgical technique, we recruited 60 high-grade lumbar spondylolisthesis patients into 2 independent groups: the long-segment PLF group, including 30 patients, and the short-segment PLIF group, including 30 patients. Methods: Each patient underwent thorough history-taking, neurological testing, and a VAS for back and leg pain. Pre-operative radiological assessment included (X-rays and MRI) and assessment of the Japanese Orthopedic Association score (JOA score). Posterior decompression with insitu posterior transpedicular screw fixation and posterolateral fusion by long segment [long-segment] fixation; and posterior decompression, reduction, and transpedicular screw fixation [short segment] with interbody fusion were the surgical techniques used. Post-operative outcome measures include VAS scale back and leg pain, post-operative JOA score, complications rate, along with patient satisfaction outcome.. Results: The study population's average age was (47.1 ± 11.2) years, with 63.3 % of females and 36.7 % of males. We found a highly significant decline in VAS ratings (back and leg pain) and a highly significant increase in JOA score in the short and long-segment PLF groups (p < 0.01 respectively). A study comparing the two groups discovered that the long-segment PLF group experienced a significantly lower rate of complications compared to the short-segment PLIF group (p < 0.05), but there have been no significant differences in postsurgical outcome (patient satisfaction) (p > 0.05). Conclusion: To conclude, both short and long-segment PLF operation techniques were proven to be equally effective regarding improvement of primary clinical outcomes (e.g., success and good satisfaction rates and VAS values for back and leg pain and JOA scores), but the complications rate was greater in the shortsegment PLIF patient group.