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M S Eljamel

Publications and source records attributed to M S Eljamel.

36 records · Page 2Linked to original sources
PubMed1994

MRI cisternography, and the localization of CSF fistulae.

Accurate localization of CSF fistulae not only makes the planning of surgery easier, but it also increases the chances of successful dural repair and eliminates negative exploration. CSF fistulae localization has been a problem for many years, and several methods have been used to pin-point the site of CSF leakage with variable degree of success. Recently, contrast CT cisternography (CCTC) has replaced radio-isotope cisternography (RIC) in many centres. However, both methods are invasive, time consuming, contraindicated in patients with intracranial mass lesions and insensitive in detecting inactive CSF leaks. Furthermore, in both, ionizing radiation is used and both techniques may lead to allergic reactions or seizures. On the other hand, T2-weighted Magnetic Resonance Imaging (MRI) shows the CSF as a high signal without the need to inject contrast media intrathecally. Furthermore, MRI demonstrates the intracranial anatomy and pathology in detail in multiple planes within a relatively short time. MRI does not involve ionizing radiation and therefore is safely repeatable. MRI using T2-weighted sequences should be an ideal tool to locate precisely the site of CSF fistulae. This paper describes our experience with MRI cisternography in CSF fistulae localization. Eleven patients with inactive CSF fistulae were investigated. MRI cisternography localized the site of fistula in each case. All patients were explored surgically and the site of CSF fistula was confirmed and repaired intradurally with a pericranial graft and fibrin glue without recurrence or meningitis.

Adolescent↗
PubMed1994

Fractures of the middle third of the face and cerebrospinal fluid rhinorrhoea.

The incidence of cerebrospinal fluid (CSF) rhinorrhoea in patients with facial fractures is about 25%. Although the management of facial fractures is well documented, its timing and role in the presence of CSF leak is still open to debate. This study evaluates facial manipulation in 89 facial fractures associated with CSF rhinorrhoea, with a mean follow-up of 4 years. The facial fractures were reduced in 26 patients (29%) and the CSF fistula was repaired in 75 (84%). Twenty-three (25.8%) had both facial manipulation and dural repair with no deaths, post operative infection, failure or recurrence of CSF leak. On the other hand, when facial manipulation or dural repair was performed alone, the CSF rhinorrhoea either persisted or recurred in a significant number of patients requiring further intervention. Although this is a retrospective analysis of patients treated over several years and, there has been a change in the methods of investigation and treatment of these patients, one can conclude that manipulation of facial fractures and surgical dural repair can be carried out at the same sitting without increasing the surgical morbidity and mortality.

Adult↗
PubMed1993

Antibiotic prophylaxis in unrepaired CSF fistulae.

The value of antibiotic prophylaxis in patients with Cerebrospinal Fluid Leakage (CSF) is debatable. The aim of this study was to determine the value of prophylactic antibiotics in these patients. The study population comprised 253 patients with definite CSF leaks, of whom 106 received adequate antibiotic prophylaxis (Group A) and 109 were not treated with antibiotics (Group B). Thirty-eight patients were excluded from the analysis because they received antibiotics for reasons other than the CSF leakage. The two groups were closely matched for age, sex, type of CSF fistula, site, and duration of CSF leakage and presence or absence of skull fractures, but there were more patients with facial fractures and pneumocephalus in those who were treated with antibiotics. The first week meningitis rate was 6.6 and 9.17% in the treated and untreated groups, respectively, while the annual risk of meningitis was 7.6% in the treated and 11.9% in the untreated group. However, these differences did not reach significance (P > 0.05). The survival curves of meningitis-free survival were similar in the two groups, particularly during the first 4 weeks during which antibiotics were given (Log Rank test, p > 0.05). Furthermore, there were more cases of Gram-negative infection and of partially-treated meningitis in the treated group. Although this was a retrospective, non-randomized study, it confirms the conclusions of previous smaller series, that prophylactic antibiotics do not significantly reduce the risk of meningitis in these patients. It is ethically justifiable to withhold antibiotic prophylaxis in patients with CSF fistulae until a prospective controlled double blind trial has settled the question.

Adult↗
PubMed1992

The use of a computer-based image link system to assist inter-hospital referrals.

Early CT scanning leads to the early diagnosis and referral of intracranial lesions, particularly in head injuries. Such early scanning is more feasible with the advent of CT scanners in most peripheral hospitals. However, the neurosurgical service in most countries remains regional with limited bed capacity and involves a potentially hazardous inter-hospital transfer of critically ill patients. We investigated the value and reliability of new information technology in the management of emergency neurosurgical referrals in the Mersey region. One hundred and ninety-nine emergency referrals were studied. In 147 referrals the patient was scanned in the referring hospital and the images were transmitted immediately to the neurosurgical unit. Of these, 51 (34.7%) patients were transferred immediately, 14 (9.5%) the following day and 11 (7.5%) electively. Of those patients who were transferred immediately, 48 (94.1%) underwent emergency surgery. Seventy-one (48.3%) patients were not transferred due to diffuse head injury (40), a cerebral infarct (15), poor grade subarachnoid haemorrhage (10) and normal scans (6). Another 52 patients were transferred to the unit without image transfer, of whom 12 (23.1%) underwent emergency surgery, 17 (32.7%) went back to the referring hospital within 24 h, 17 (32.7%) were electively operated and six (11.5%) died. Comparison of 100 original CT scan films with the corresponding transmitted images showed no significant difference in the quality of the image, diagnosis or clinical decision. Image transfer together with the clinical history has reduced potentially hazardous inter-hospital transfer of patients (p < 0.001). It is reliable, fast, cheap and leads to considerable economic savings.

Adolescent↗
PubMed1991

Non-traumatic CSF fistulae: clinical history and management.

Non-traumatic 'spontaneous' CSF fistulae are uncommon. The clinical features of 23 patients treated for non-traumatic CSF fistulae are presented. Twenty of these patients had normal CSF pressure and six developed meningitis. Surgical repair of these fistulae is recommended in order to reduce the risk of meningitis. For this their localization is essential.

Adolescent↗
PubMed1990

Dissection of the cervical internal carotid artery. The role of Doppler/Duplex studies and conservative management.

Cervical internal carotid dissection is not rare. Doppler ultrasound screening of young patients presenting with stroke, identified 10 patients with reduced common and internal carotid blood flow without any evidence of atheroma. Eight, on angiography proved to have a dissection of the cervical internal carotid artery. All were managed conservatively. Seven received anticoagulant therapy, stopping any further neurological symptoms.

Adolescent↗
PubMed1990

Acute traumatic CSF fistulae: the risk of intracranial infection.

The management of acute traumatic cerebrospinal fluid (CSF) fistulae is still a matter of debate and hinges about what is perceived to be the risk of subsequent intracranial infection. We have therefore carried out a retrospective analysis of 160 cases of traumatic CSF leaks to assess the incidence, cumulative risk and prognosis of intracranial infection. The overall incidence of meningitis in this group before surgical dural repair was 30.6% (49/160), the cumulative risk exceeded 85% at 10 years follow-up and the meningitis was fatal in 4.1% (2/49). The recurrence of CSF leakage after initial spontaneous cessation was 7% and meningitis was recurrent in 30.6% (15/49). Prophylactic antibiotics had reduced the risk of meningitis from 61 to 34%. The commonest pathogen was pneumococcus and the CSF leakage had stopped within 7 days in 60% of those who developed meningitis and in 50% of those who did not develop meningitis. Meningitis is still a serious complication of post-traumatic CSF fistulae and is potentially fatal despite modern therapeutic agents.

Adolescent↗
PubMed1990

Post-traumatic CSF fistulae, the case for surgical repair.

The management of acute post-traumatic CSF fistulae is still a matter of controversy. A long-term analysis of 160 patients with acute post-traumatic non-iatrogenic dural fistulae was undertaken to establish the value of surgical dural repair. One hundred and forty-nine patients underwent dural repairs following traumatic CSF rhinorrhoea. The risk of meningitis following surgical dural repair was 4%. The operative mortality was 1.3% (2/151), as was the negative exploration rate. The first dural repair was successful in 90% and a second dural repair was required in 10%. These results are in favour of surgical dural repair which can be undertaken with a low morbidity and mortality and is highly successful in preventing meningitis following traumatic CSF rhinorrhoea.

Adolescent↗
PubMed1989

Multiple meningiomas and their relation to neurofibromatosis. Review of the literature and report of seven cases.

A review of 158 cases of multiple meningiomas reported in the literature and 7 additional cases are presented. The average incidence of multiple meningiomas is 2.5% of all meningiomas. In the absence of cutaneous manifestations of von Recklinghausen's disease, it is extremely difficult to distinguish between cases associated with central neurofibromatosis and those representing true multiple meningiomas. There are no specific pathognomonic features that distinguish true multiple meningiomas as a separate disease entity.

Adult↗
PubMedDate not supplied

Acoustic neuromas: a review of 58 patients and correlation of tumour-size to the outcome.

Fifty eight patients with acoustic neuromas, who presented over a six year period were reviewed. These patients were sub divided into three groups according to their tumour size. Group A comprised of 21 patients with lesions less than 2 cm in diameter, of which 83% presented in the last two years. Group B comprised of 30 patients with lesions measuring 2-4 cm, of which 43% presented in the last two years. Group C included 7 patients with lesions greater than 4 cm in size, of which 14% presented in the corresponding period. The relative increase in the number of patients in Group A and decrease in Group C over the years is a direct reflection of heightened clinical awareness and increased usage of magnetic resonance imaging for diagnosis. Complete surgical excision was achieved in 20/21 patients in Group A and 4/7 patients in Group C, with an overall complete excision rate of 81%. The overall facial nerve preservation rate was 81% of which 20/21 patients were in Group A, 23/30 in Group B and 4/7 in Group C. The surgical morbidity ranged from 10% in Group A to 28% in Group C. There were no deaths in Group A compared to two each in Group B and Group C. This emphasises the importance of early detection and treatment of acoustic neuromas when they are small.

Aged↗