Romanian Neurosurgery <p>Call for Papers -&nbsp;Vol. XXXIII, No. 3 (September 2019)<br>Submission Deadline: August 1, 2019&nbsp;</p> en-US (Dr Stefan Mircea Iencean) Sat, 15 Jun 2019 00:00:00 +0000 OJS 60 Continuous intracranial pressure monitoring in severe traumatic brain injury in children <p>We present the results of the Romanian team for the multi-center grant “Paediatric&nbsp;Brain Monitoring with Information Technology (KidsBrainIT). Using IT Innovations to&nbsp;Improve Childhood Traumatic Brain Injury Intensive Care Management, Outcome, and Patient Safety”, acronym KidsBrainIT. Children aged 2 to 16 years who require intensive care management after sustaining traumatic severe brain injury are included in this study in three neurosurgical hospital: "Prof. Dr. N. Oblu" Clinical Emergency Hospital Iasi, "Sf. Maria" Children Clinical Emergency Hospital Iasi and "Bagdasar-Arseni" Clinical Emergency Hospital Bucharest. Continuous real-time intracranial pressure monitoring became a "gold standard" in TBI intensive-care management and ICP-lowering therapy is recommended when ICP is elevated above 20 mmHg or more. Continuous ICP and mean arterial blood pressure (MAP) monitoring allow calculation of cerebral perfusion pressure (CPP) and to establish of an optimal CPP. This study aims to improve the treatments and the outcomes in severe traumatic brain injury in children.</p> St. M. Iencean, A. Tascu, C. A. Apetrei, C. Gheorghita, Tsz-Yan Milly Lo, Ian Piper, A. St. Iencean ##submission.copyrightStatement## Sat, 15 Jun 2019 00:00:00 +0000 Tailored approach for the resection of planum sphenoidale meningiomas <p><strong>Background and importance.</strong> Planum sphenoidale meningiomas are relatively rare tumours that can grow to a considerable size before determining noticeable symptoms. Modern imaging techniques can detect these tumours of varying size. Surgical resection of planum sphenoidale meningiomas can be performed by adapting the approach to the size of the tumour.<br><strong>Clinical presentation.</strong> A 56-year-old woman presented with a small (2 cm in diameter) planum sphenoidale meningioma that was resected through a frontal craniotomy performed with a 4,5 cm trephine at the level of the frontal sinus. The second case is that of a 55-year-old woman that presented with a large planum sphenoidale meningioma (5,6 cm in the antero-posterior plane and 5,5 cm cranio-caudally) extending to the tuberculum sellae and sellar diaphragm, reaching the anterior wall of the third ventricle. In this case, a bifrontal craniotomy was performed with frontal sinus cranialization and resection of falx cerebri, achieving a Simpson II resection. Both cases presented a favourable postoperative evolution, without any deficits and an excellent cosmetic result.<br><strong>Conclusion.</strong> The approach for tumours of the anterior skull base must be tailored to the size of the tumour. A minimally invasive approach through the frontal sinus should not be avoided in cases with small tumours.</p> Oana-Mihaela Punga, Cristiana-Elena Moisescu, D. Iftimie, D. Adam ##submission.copyrightStatement## Sat, 15 Jun 2019 00:00:00 +0000 Biomarkers of the brain injuries - the future diagnosis standard in head trauma? <p>Acute head trauma is often a clinical challenge in diagnosing the brain damage, assessing its severity and prognosis, and establishing the optimal treatment. Different patients, with brain damage of apparent comparable severity according to the imaging examination, may have different neurological evolution or different response to therapy.<br>Minor traumatic brain injuries can induce a brief loss of consciousness or confusion, are usually benign, but sometimes they cause persistent and progressive brain symptoms in the long run. However, at present, there are no reliable methods that can diagnose properly minor traumatic brain injuries.<br>Biomarkers of the brain injuries allow the monitoring of both physiological and pathological processes. The identification of such biomarkers could allow a better understanding of the pathological processes involved in traumatic brain injuries, their diagnosis, prognosis and may facilitate the establishment of a better treatment regimen for these patients.<br>In this article, the authors make a brief review of the literature in which they analyse the biomarkers of the lesions of the various brain structures identified so far, which can be detected in biological fluids (blood, cerebrospinal fluid) and the advantages and limitations of their use in the current medical practice.</p> Andreea Elena Bîrlescu, Bianca Hanganu, Andreea Alexandra Hleșcu, Irina Smaranda Manoilescu, Beatrice Gabriela Ioan ##submission.copyrightStatement## Sat, 15 Jun 2019 00:00:00 +0000 Dual microcatheter technique for the treatment of a ruptured wide neck basilar tip aneurysm <p>Endovascular treatment is a safe and efficient therapy for intracranial aneurysms with lower complication and mortality rates compared to surgical clipping. Wide-neck aneurysms still represent a challenge to complete and safe aneurysm occlusion in spite of techniques such as stent-assisted or balloon-assisted coiling, developed in order to achieve better occlusion rates. These techniques themselves may lead to further complications, so alternative methods such as the dual microcatheter technique were developed. This technique assumes that, via two microcatheters inserted into an aneurysm, simultaneous deployment of two coils achieves a stable coil frame without the use of adjunctive devices. The aim of this paper is to present a successfully treated basilar tip wide-neck aneurysm treated with the dual microcatheter technique.<br>Case report. A 46-year-old male patient with acute onset of severe headache presented in the emergency room with altered state of consciousness. Non-enhanced CT scan showed subarachnoid and intraventricular haemorrhage. CT angiography revealed a wide-neck basilar tip aneurysm. Digital subtraction angiography confirmed the presence of an aneurysm with a wide, 4.9 mm neck.<br>Dual microcatheter technique was chosen as the first treatment option, while a hypercompliant balloon was kept as backup. Two microcatheters were placed inside de aneurysm and two coils were introduced in order to form a stable framing coil mass that served as a support for further coils deployed in an alternately manner through each microcatheter. No procedural complication occurred, and the patient’s evolution was uneventful with no neurological deficits at discharge.<br>Conclusion. The dual microcatheter technique is a safe and effective therapeutic option for wide-neck ruptured or unruptured intracranial aneurysms. Periprocedural complication rates are similar to simple coiling or balloon-assisted coiling, but lower than for stent-assisted coiling.</p> Rares Filep, Dorin Nicolae Gherasim, Septimiu Popescu, Botond Tokes, Lucian Marginean ##submission.copyrightStatement## Sat, 15 Jun 2019 00:00:00 +0000 New technologies for low-grade glioma surgery <p>Brain surgery has come far from the primitive methods used thousands of years ago. In the last hundred years alone, we have come across countless breakthroughs like the invention of bipolar coagulation, the surgical microscope, microsurgical techniques and a large variety of surgical instruments. The latest years have brought us neuro-navigation, intra-operative imaging techniques and brain activity monitoring. Low-grade glioma surgery, in particular, has taken advantage a lot from all these new methods, bringing great benefits for the patients: the safe extent of resection has grown progressively and tumours located in eloquent areas that were thought until recently to be inoperable, have started to be removed in safe conditions. The purpose of this paper is to present these new technologies as a recap for neurosurgical professionals.</p> Nicolae-Ștefan Bogaciu, Daniel Teleanu, A. V. Ciurea ##submission.copyrightStatement## Sat, 15 Jun 2019 00:00:00 +0000 Initial single centre experience with Barrel VRD stent in large neck aneurisms <p><strong>Introduction.</strong> Despite the use of new techniques, such as Y-stenting, the waffle-cone technique and intrasaccular flow disrupters the treatment of wide-neck bifurcation aneurysms is still challenging, especially for those where adjacent branches are arising at the neck level. Moreover, the use of flow diverter stents in bifurcation aneurysms has been proposed by several teams, although the results remain controversial.<br>This study is reflecting initial experience in our department with a relatively new device available on the market: Barrel VRD stent. The unique design feature of the device is the “belly-like” central part of the stent which protects the adjacent branches.<br><strong>Methods.</strong> We retrospectively reviewed all patients in whom stenting with braided or laser-cut stents had been performed in our center. Three patients were identified and analyzed. Technical success, complications, immediate angiographic outcomes, procedural data, are reported here.<br><strong>Results.</strong> One MCA bifurcation and two basilar tip large neck aneurysms with one branch arising from the neck level have been identified. Technical success was achieved in all procedures. Overall procedure-related morbidity and mortality was 0%. In the immediate post-treatment angiography, adequate occlusion (neck remnant or total occlusion) was observed in all patients. Short- and mild-term follow-up angiography showed adequate occlusion of the aneurysms.<br><strong>Conclusions.</strong> In this small case series, retrospective single-center analysis we showed&nbsp;that Barrel VRD - stent assisted coiling is a safe and feasible technique. Moreover, it offers an elegant and effective endovascular solution for large neck basilar tip aneurysms on which the neurosurgical clipping remains challenging.</p> Cristian Mihalea, Felicia Otilia Humulescu, Hazem Abdelkhalek, Sorin Pescariu, Bogdan Valeriu Popa, Horia Ples ##submission.copyrightStatement## Sat, 15 Jun 2019 00:00:00 +0000 Correlations between clinical, imaging and histological findings in a patient with neurofibromatosis type 1 (von Recklinghausen's disease) <p>Neurofibromatosis type 1 (NF1) or von Recklinghausen disease is one of the most common genetic diseases, affecting 1/4,000 individuals. It is transmitted by autosomal dominant inheritance and the gene NF1, which is responsible for the disease, is located on the long arm of chromosome 17. NF1 is characterized by varied expressions of the disease, even within the same family.<br>We present the case of a 22-year-old patient with NF1 admitted in the Department of Neurosurgery for a two months history of diffuse intercostal nevralgias that did not respond to treatment and discuss the histopathological and immunohistochemical features of her cutaneous and spinal neurofibromas.<br>Our case adds new data to the knowledge of the diverse biological behaviour of NF1, highlighting the fact that this condition is a complex disease even in the same individual. We report here a highly variability among neurofibromas in the same patient from a histopathological point of view. Our data are also important as they demonstrate the fact that the management of a patient with NF1, due to the various and complex manifestations of the disease, requires a multidisciplinary approach, including neurologist, neurosurgeon, ophthalmologist, plastic surgeon, derma-tologist, radiologist and pathologist.</p> Gabriela Florența Dumitrescu, Anca Sava, Ion Poeată, Danisia Haba, Bogdan Dobrovăț, Nicoleta Dumitrescu, Camelia Margareta Bogdănici, Claudia Florida Costea ##submission.copyrightStatement## Sat, 15 Jun 2019 00:00:00 +0000 Experience of choroid plexus papilloma in children at Mansoura University Hospital <p>Choroid plexus papilloma (CPP) are rare, benign tumours of neuroectodermal origin; they represent 1-3% of central nervous system (CNS) tumours in paediatric patients. Authors present their experience in the management of such lesion in Mansoura University Hospitals.<br><strong>Methods.</strong> For children with Choroid plexus papilloma who were treated via microsurgical excision over 4 years from January 2012 to January 2016 in Mansoura University Hospitals, a retrospective analysis was done for age, sex, clinical manifestations, surgical treatment and follow up.<br><strong>Results.</strong> Twenty-three paediatrics were treated over 4 years. Age ranged from (7 months - 8 years). There were 13 female and10 males. Tumours were located in the lateral ventricle in all cases. Features of raised intracranial pressure were the predominant presentation. Total microsurgical excision was achieved in all cases. All cases had intraoperative blood loss &lt; 100 ml with mean Haematocrit 28%. Follow up period (7-53 months). Complete relief of all symptoms was reported in all cases with no mortality. One of our patients needs postoperative ventriculoperitoneal shunt for persistent CSF leakage and another one required subdural peritoneal shunt for persistent subdural CSF collection.<br><strong>Conclusion.</strong> Total excision of Choroid plexus papilloma is usually the rule with an excellent outcome. Routine external ventricular drainage for at least 3 days is effective in lowering shunt-dependent cases as it allows the release of bloody CSF and small tumour residue. With proper microsurgical technique through superior parietal lobule to access lateral ventricle then tumour coagulation at the same time of irrigation that helps the tumour to shrink and thus, decrease the incidence of bleeding. The tumour vascular pedicle should be resected with the last part of the tumour to avoid pedicle retraction that may lead to ventricular haemorrhage.</p> Hatem Badr, Ahmad Zaher, Mohamed State, Amr Farid Khalil ##submission.copyrightStatement## Sat, 15 Jun 2019 00:00:00 +0000 Hydatid cyst of the quadrigeminal cistern <p>Intracranial hydatid cyst involves supratentorial area and mainly affecting the middle cerebral artery territory with the predilection of the partial lobe. It can be single - which is the most common - or multiple up to 35 cysts. They tend to be huge at the time of symptomatic presentation especially when they are presented as a solitary lesion with a slow growth rate around 1.5 cm/year, however, it is variable and it can be up to 10 cm/year. Surgical treatment is mandatory for all patients once the correct diagnosis is made, except for patients with multiple organ involvement in poor general conditions and deep-located cysts. The existence of hydatidosis in the cisternal spaces must not be neglected given the capacity of E. granulosus larvae to disseminate via the CSF. In this case report; two and half years’ male child presented with a history of 2 attacks of generalized seizure for the last 72 hours with the head circumference at the upper normal limit for his age. This paper presents the first case report demonstrating a primary single hydatid cyst located in the quadrigeminal cistern in a child. We concluded that in spite of the feasibility of the imaging and the high suspension of cerebral hydatid cyst, still, the reports show more locations which can be described as unusual although for a head to toe suspected distribution of hydatid disease is already understood. An eminent medical and surgical (if indicated) treatment of the primary cerebral hydatid cyst are always effective and recommended.</p> Saif Saood Abdelrazaq, Abdullah H. Al Ramadan, Ali Adnan Dolachee, Mohammed Maan AbdulAzeez, Ali Saud Abdulrazzaq, Amar Saeed Rashid, Samer S. Hoz ##submission.copyrightStatement## Sat, 15 Jun 2019 00:00:00 +0000 Cerebral pilocytic astrocytoma with spontaneous intratumoral haemorrhage in the elderly - a rare entity <p>Pilocytic astrocytomas (PA) are histologically are low-grade tumours, commonly found in the paediatric and young adult population. Although cases of adult and elderly pilocytic astrocytomas are described in the literature, they are quite uncommon. The rate of PAs with spontaneous bleeding is very less, with a high occurrence in children than in adults, moreover, that is in cerebellar PAs. Cerebral PAs with intratumoral haemorrhage in the older age group is extremely rare. We present a case of a 60-year female presenting with acute neurological compromise resulting from an acutely haemorrhagic Left temporal pilocytic astrocytoma. She was managed surgically with evacuation of tumoral haemorrhages, as well as resection of the tumour. Postoperatively the patient made a remarkable recovery.</p> Amit Narang, Varun Aggarwal, Divya Kavita, Chandni Maheshwari, Prajjwal Bansal ##submission.copyrightStatement## Sat, 15 Jun 2019 00:00:00 +0000 Traumatic posterior fossa extradural hematoma <p><strong>Background.</strong> Extradural hematoma of posterior fossa (PFEDH) is less common and there are not many articles about PFEDH. These patients can deteriorate very rapidly due to compression over brainstem. Thus, early identification and immediate intervention can save the lives of these patients.<br><strong>Objective.</strong> This study aims to conduct a comprehensive analysis of patients with PFEDH and evaluate the postoperative outcome which may be of help to make further preventive strategies.<br><strong>Methods and Materials.</strong> The study included 16 patients admitted with traumatic PFEDH from July 2016 to July 2018 at R.N.T. Medical College &amp; M.B. Groups of Hospital Udaipur, southwestern Rajasthan, India. We have retrospectively reviewed the data. Analysed factors were gender, age, Glasgow Coma Scale (GCS), Noncontrast CT scan findings, associated brain injury, type of intervention, Glasgow Outcome Scale (GOS). GOS was assessed at discharge, at 3 months and 6 months follow-up.<br><strong>Results.</strong> Out of a total of 16 patients, 11 were male and 5 were female with age ranging from 05-46 years. 12 patients had GCS 13 -15 at admission and only one of them had GCS &lt; 8. 15 patients underwent surgical intervention. At 6 months follow-up, 12 patients had good recovery GOS is 5.<br><strong>Conclusion.</strong> Early detection and immediate evacuation of PFEDHs should be done if causing fourth ventricle, basal cistern or brain stem compression. It may be rapidly fatal due to the expansion of hematoma leading to brainstem compression, tonsillar herniation, and/or obstructive hydrocephalus. Early detection and immediate evacuation lead to a better outcome in these patients.</p> Vibhu Shankar Parashar, Vivek Kumar Kankane, Gaurav Jaiswal, Tarun Kumar Gupta ##submission.copyrightStatement## Sat, 15 Jun 2019 00:00:00 +0000 Secondary (Duret) brainstem haemorrhage may not always represent a fatal event <p><strong>Background.</strong> Secondary brainstem haemorrhage (eponymously called Duret haemorrhage) is a well-known complication of transtentorial brain herniation or of rapid decompression of intracranial space. It is considered to be a consequence of arterial rupture, venous infarction or ischemia-reperfusion injury and it is regarded as a harbinger of an unfavourable outcome for the patient. Despite this, several case reports describing good outcome after Duret haemorrhage preceded by evacuation of an expansive traumatic intracranial mass lesion, an episode of intracranial hypotension or lumbar drainage have been published.<br><strong>Case description.</strong> We present four cases of patients with secondary brainstem haemorrhage linked to an episode of intracranial hypertension due to various reasons who were treated at our clinic. The first patient suffered a small brainstem haemorrhage that was described on his initial CT scan presumably as a result of massive intracranial expansion caused by an acute subdural haematoma and this Duret haemorrhage markedly expanded after the subdural haematoma was evacuated by means of a decompressive craniectomy. The next two patients developed Duret haemorrhage after the evacuation of intracranial haematomas. The fourth patient presented with posttraumatic cerebral oedema complicated by a subtle Duret haemorrhage displayed on his initial CT scan and this bleeding remained stable even after a bilateral decompressive craniectomy. One patient passed away, one remained in a persistent coma and two survived with a light neurological deficit.<br><strong>Conclusions.</strong> However ominous a newly discovered Duret haemorrhage may be, it alone should not discourage us from the further intensive treatment of our patients as their outcome may considerably vary. The extent of this bleeding, type and severity of underlying brain injury and complete clinical status and history of our patients should all be taken into account when deciding about patients’ prognosis.</p> Martin Hanko, Branislav Kolarovszki, Kristián Varga, René Opšenák, Pavol Snopko, Radoslav Hanzel, Kamil Zeleňák ##submission.copyrightStatement## Sat, 15 Jun 2019 00:00:00 +0000 Spinal extradural meningioma en plaque with nerve root attachment and extracanal (intrathoracic) extension <p>Meningiomas are relatively common primary spinal tumours, being the second most common intraspinal tumours probably after vertebral haemangioma.<br>It constitutes about 25% of all intraspinal tumours; however, in the presence of extradural spinal lesions, the diagnosis of meningioma is uncommon and often not among the first two considerations. Purely extradural spinal meningioma, especially of the “En plaque” variety, usually simulate malignant disease (metastatic diseases and lymphoma) and may result in inadequate therapy, however, the presence of nerve root attachment is even rarer.<br>Our case report is that of an entirely cervicothoracic extradural en‑plaque meningioma (WHO grade 1) with a nerve root attachment (right C7) and intrathoracic extension. We highlighted the issues in diagnosis, operative intervention and long-term follow-up.</p> E. Morgan, M. Hakkou, A. Mellaoui, E. Poluyi, A. El Ouahabi ##submission.copyrightStatement## Sat, 15 Jun 2019 00:00:00 +0000 The evaluation of long-term screw pull-out rates following posterior thoracolumbar fusion surgery with short and thin pedicle screws <p><strong>Background.</strong> The aim of this study was to evaluate screw pull-out rates after fusion&nbsp;operations with short and thin pedicle screws.<br><strong>Methods.</strong> A total of 200 posterior lumbar and thoracolumbar fusion operations&nbsp;performed at our clinic with short and thin pedicle screws (5.5x35 mm) were&nbsp;retrospectively evaluated. The patients were assessed with computed tomography&nbsp;postoperatively on the day of surgery and at the 6th month. Single groove retraction&nbsp;of the transpedicular screw was evaluated as pull-out. The results were evaluated by&nbsp;the 'number of pull-out cases / total number of cases' and also the 'total number of&nbsp;pull-out screws / total number of screws used' ratios.&nbsp;<br><strong>Results.</strong> There were 112 (56%) female and 88 (44%) male patients with a mean age&nbsp;of 58 years. The total number of screws used in the 200 cases was 1188. There were&nbsp;88 (7.4%) thoracic pedicle screws, 1056 (88.9%) lumbar pedicle screws and 44 (3.7%)&nbsp;sacral pedicle screws used. No pull-out was found in the control CTs taken&nbsp;postoperatively. Left side T11 and T12 pull-out was observed in one case and left L4&nbsp;pull-out was observed in another case in the control CTs taken at the postoperative&nbsp;6th month. Pull-out was observed in 2 (1%) of the 200 cases and 3 (0.25%) of the 1188&nbsp;screws.<br><strong>Conclusions.</strong> All the short and thin pedicle screws used had passed the pedicle length&nbsp;and neurocentral junction. The use of a 5.5x35 mm screws in fusion operations is less&nbsp;invasive than using longer and thicker screws while the pull-out rates may be similar.</p> Umit Kocaman, Hakan Yilmaz ##submission.copyrightStatement## Sat, 15 Jun 2019 00:00:00 +0000 Traumatic complete transection of dorsal spinal cord un-associated with spinal fracture or subluxation <p>Complete transection of spinal cord is an extremely rare occurrence, and usually associated with spinal instability, fracture or spondylolisthesis and also have associated systemic polytrauma involving multiple organs injury. However, a complete transaction of spinal cord unassociated with fracture or dislocation or without abnormality on X-ray and CT scan imaging is extremely uncommon. Kalfas et al. observed 11.2 % of cases had cord transection in the study of sixty-two cases spinal cord-injured patients, who underwent spinal MRI, were additionally had evidence vertebral injury. In 2010, Cha et al reported the first case of transection of cord in the cervical region in a 34- year- adult male, as the first case in literature, which was not associated with any vertebral body fracture or dislocation. Authors report an interesting case, 15-year boy, who had complete transection of the spinal cord associated with polytrauma following a motor vehicle accident, spinal X-ray and CT scan imaging was unremarkable, however spinal MRI scan established the diagnosis. Briefly, imaging, management and pertinent literature are reviewed.</p> Guru Dutta Satyarthee, Satyajit Panda ##submission.copyrightStatement## Sat, 15 Jun 2019 00:00:00 +0000 Post traumatic isolated ipsilateral oculomotor nerve palsy <p>The common causes of isolated third nerve palsy are microvascular infarction, intracranial aneurysm, diabetes, hypertension and atherosclerosis. Here we are presenting a case of 26-year female presenting with a history of head injury two months back. She presented with ptosis on the left side. On computed tomography, a large left-sided chronic subdural hematoma with significant midline shift was found. Isolated ipsilateral third nerve palsy is a rare presentation with unilateral chronic subdural hematoma. Improvement in ptosis after surgery indicate a good neurological outcome.</p> Praveen Kumar, Sharad Pandey, Kulwant Singh, Mukesh Sharma, Prarthana Saxena ##submission.copyrightStatement## Sat, 15 Jun 2019 00:00:00 +0000 Endoscopic management of intraventricular shunt-related cystic compartment in paediatric patients <p><strong>Background.</strong> Intraventricular uniloculated compartments are relatively seen frequently in children previously treated with ventriculoperitoneal shunts for hydrocephalus. These compartments may present before shunt insertion and even as an end result to the shunt gliosis. Although the availability of different surgical modalities for the management of such loculations but till now there is no consensus about a single therapeutic approach for its management. <strong>Objective.</strong> The aim of this study is to assess the role of neuroendoscopy in management of uniloculated compartments, in pediatric cases who underwent shunting for hydrocephalus, to avoid multiple shunt insertion and even to eliminate the need for the preexisting shunt system.<br><strong>Patients and Methods.</strong> We retrospectively studied 44 consecutive previously shunted patients with isolated intraventricular compartment who underwent 58 endoscopic procedures by a single surgeon during the period between February 2015 and February 2018. These procedures included endoscopic cyst fenestration, intraventricular septum pellucidotomy, foraminoplasty and additionally third ventriculostomy in some cases was added to the previous procedures. Multiloculated hydrocephalus and cysts related to the tumours were excluded. Clinical, radiological and surgical data were assessed.<br><strong>Results.</strong> The most common cause of a single loculation in those patients was neuroepithelial cyst (20 cases) followed by post shunt isolated compartment (12 cases), meningitis (8 cases) and four cases of intraventricular haemorrhage. The patient's age varied from two months up to seven years (mean = 3.2 years). The follow-up period was ranged from (2-49 months) with the mean of 12.3 months. The overall success of restoration of communication between the uniloculated compartment and the ventricular system was achieved in 36 patients (81.8%), with 28 (63.6%) patient needed only one shunt and eight (18.2%) patients became independent of their previous shunts. Fourteen repeated endoscopic procedures were considered necessary in ten patients for either reopening of a closed stoma and/or shunt revision and finally, eight patient (18%) required additional shunt insertion during follow up period. The complications encountered were minor and reversible (CSF leak in two cases, infection in two cases, subdural fluid collection in four cases) with no mortality.<br><strong>Conclusion.</strong> Minimal invasive endoscopic technique is a useful operative alternative to control uniloculated compartments in patients with previous ventriculoperitoneal shunts. It does not only simplify the existing shunt system by restoration of the communication between the loculated compartment and the draining shunt but it may eliminate the need for external shunt in some cases as well.</p> Ahmed Zaher, Amr Farid Khalil, Mohamed State, Hatem Badr ##submission.copyrightStatement## Sat, 15 Jun 2019 00:00:00 +0000 The use of folic acid in the prevention of spinal bifida <p><strong>Background.</strong> Spinal Bifida is a congenital malformation of the spine that typified defect of the neural tube with devastating neurological, psychosocial and developmental burden to the growing child with associated huge financial burden to the parents, community and the country. Past and present studies have shown strong evidence to indicate that folic acid supplementation during the periconceptional period reduces the occurrence of spinal bifida in children.<br><strong>Aim.</strong> To assess the knowledge, attitude, and practice of use of folic acid during the periconceptional period among women of childbearing age in two rural communities in Edo State, Nigeria.<br><strong>Materials and methods.</strong> A prospective cross-sectional study of 170 women between the ages of 15 and 49 years recruited through a multi-stage sampling technique. The survey instrument was a structured interviewer-administered questionnaire. The data was analysed using Statistical Package for Social Sciences (SPSS) version 21 and presented as charts, tables, and associations tested with Chi-square at a statistical level of significance set at p&lt;0.05.<br><strong>Results.</strong> One hundred and twenty-two (71.8%) of the respondents showed good knowledge, 147(86.5%) had a positive attitude, and 106 (62.4%) had a good practice of use of folic acid. There was a statistically significant association between respondents’ age, marital status, level of education, occupation, and their knowledge of the use of folic acid as well as with their attitude towards the use of folic acid. However, the practice was mainly associated with the socio-demographic variable of each household.<br><strong>Conclusion.</strong> The use of folic acid during the perinatal period for the prevention of&nbsp;spinal bifida is found to be absent in about two-fifths of the study population, a number found to be alarming despite the high level of good knowledge and attitude towards the use of folic acid. There is, therefore, an urgent need to step up more advocacy and health education to women of childbearing age to increase the uptake of folic acid for effective reduction of the incidence of spinal bifida.</p> Eghosa Morgan, Nosa Akpede, Emmanuel Friday Osagiede, Vivian Ajekweneh, Francis Erah, Victoria Aishetu Momoh, Mohammed Irumhekhai Momoh, Ezemwenghian Aikomien Morgan, Ese Tracy Osagiede ##submission.copyrightStatement## Sat, 15 Jun 2019 00:00:00 +0000