33 years old male presented as a case of road traffic accident with coma to emergency unit. Brain CT scan revealed a large left frontal depress fracture. Surgical interference to remove depress bone with suturing dural tear. 2ed postoperative day he return to full consciousness and discharge to home.

Brain CT scan show depress fracture

Brain CT scan

(bone window)

young patient 19 years old had a headache with right side weakness. Brain MRI showed right cerebellar mass (PFT). Posterior fossa approach with complete excision of the mass done. Histopathologycal results show medulloblastoma, he refused radiation. The patient completely freeing from any symptom for one year, after that he became complain from repeated vomiting and right side weakness. Brain MRI showed recurrent tumour at the posterior fossa. Urgent ventriculoperitoneal shunt inserted was done to decrease intracranial pressure. After 2 weeks re-exploration and complete excision was done. The  histopathologycal results show medulloblastoma nodylar type.

Brain MRI

showed PFT

Brain MRI 6-3-07

showed recurrent PFT

Brain MRI postop. PFT disappear

Child 10 years old had head trauma with large screw driver  penetrating his skull. Brain CT scan revealed the screw driver penetrated about one inch inside his brain. Urgent surgical intervention was done to remove the screw driver carefully under general anesthesia with repair of the brain damage. In the first postoperative day, he was very well with no serious complications.

skull x-ray

Brain CT scan  screw driver penetrated   brain

Child 14 days old had congenital dorsal meningomyelocele. Operated with total excision of the sac and dural repair.

30 years old male exposed to road traffic accident.  He had breathing difficulty  with loss of the ability to move   both legs. Urgent chest tube inserted to evacuate blood collection inside the chest . Dorsolumbar MRI showed severe fracture at D8-D9 with spinal cord compression. Internal vertebral column fixation with spinal cord decompression  was done.

dorsal x-ray  showed  fracture at D8-D9

MRI showed  fracture at D8-D9

10 years old male had congenital encephalocele with hydrocephaly, ventriculoperitoneal shunt inserted since the 1st year of his life. Presented with 4 months history of headache and repeated vomiting. During examination, he had a small mass in the back of his head with bilateral papilledema. Brain CT scan revealed hydrocephaly. Operation  was done on 18-2-07 with total excision of encephalocele , insertion of new shunt and removal of the old one. During postoperative day, the patient became very well with no more headache and vomiting.

Brain CT scan show diluted ventricle

Brain CT scan show encephalocele

35 years old female had a headache with visual deterioration for 3 months. Repeated vomiting and inability to walk for one month. Brain CT scan revealed a 7x4 cm mass at left frontal region. Surgical intervention on 13-2-07 with very vascular tumor and she received 9 pints of blood. The mass removed completely and sent for histopathology.

Brain CT scan without contrast

Brain CT scan with contrast

2 days old infant had a congenital occipital encephalocele. Operated with total excision of the sac and dural repair.

70 years old female had aheadache for one year, complete paralysis of left side of the body and weakness of the right side. Brain MRI showed anterior foramen magnum mass severely compressing the junction of brain stem and spinal cord. Total excision was done on 11-2-07, and sent for histopathology.

Brain MRI without contrast

Brain MRI with contrast

65 years old male had right sided weakness for one month with aheadache. Brain CT scan revealed a big right frontal mass.  Operated on 4-2-07,  total left frontal lobectomy was done and sent for histopathology. The result showed diffuse astrocytoma grade 2.

Brain CT scan

Brain MRI with contrast

17 years old male had a headache with repeated vomiting for 3 months. Brain CT scan showed a posterior fossa mass compressing the fourth ventricle causing hydrocephaly. Urgent ventriculoperitoneal shunt was done. The   vomiting and headache disappeared. After 2 weeks, total removal of posterior fossa mass. The histopathology result revealed desmoplastic medulloblastoma.

Brain CT scan before surgery

Brain CT scan after surgery

25 years old male had complaining  of generalized tonic clonic attack of fit. He had history of meningitis in the first year of  his life.  In last 6 months, he received medication for  submandibular tuberculosis.  Brain MRI showed left frontal suprasylvien mass. Subtotal excision was done, postoperatively the patient  became very well. Histopathology revealed diffuse astrocytoma grade 2 ,so he was sent  for radiotherapy to complete his management.

Brain CT scan

Brain MRI T1

Child 8 years old with congenital hydrocephaly with ventriculoperitoneal shunting was done since the third month of his life. A mass developed in the way of his shunt for one week. Surgery was done and showed   infected shunt with pus collection in the mass with consequent removal of the shunt at 16-1-07.On the first postoperative day, he developed repeated vomiting. Brain CT scan revealed intraventricular hemorrhage ,  urgent external ventricular shunt with heavy antibiotics cover to prevent meningitis. After 8 days, left frontal ventriculoperitoneal shunt was done. He improved gradually and discharged  home very well.

Brain CT scan before surgery

72 years old male had spastic limbs, headache and loss of speech. He was admitted to neuromedical ward, diagnosed and managed as a case of meningeal tuberculosis. The patient had a good improvement. After one month, he was  deteriorated with progressive spastic weakness of limbs. Brain CT scan showed hydrocephaly as complication of meningeal tuberculosis. High pressure ventriculoperitoneal shunt was done to correct his condition.

Brain CT scan show diluted ventricle

Brain CT scan after shunt surgery

49 years old male had multiple intracranial shell injury. He was  confused  with impairment of vision. Brain CT scan showed two inlet at left occipital area, one of them impacted in the bone and the other perforated and arrested at the right parietal lobe. Immediate surgery was done:

1-Removal of left shell.

2-Craniectomy at left occipital bone with dural patch (site of shell entrance).

3-Craniotomy to the right parietal bone for evacuation of intracerebral hematoma.

After 3 days, he got good improvement in his vision.

Brain CT scan  1st entrance site

Brain CT scan 2nd entrance site

12 years old male Presented as scalp mass at right temporal area. Brain CT scan revealed a bony erosion with soft tissue swelling. Surgical total excision with removal of  unhealthy bony margin. Histopathology result showed a histiocytosis mass.

Brain CT scan bony defect

45 years old female had a headache for 2 years. In the last 6 months she developed right sided parasthesia and numbness with visual deterioration on the right eye. Brain MRI showed  parasellar mass engulfing the right optic nerve and optic chiasm with pressure on the left optic nerve. Surgical intervention under  microscopical field was done. Complete freeing of the right optic nerve, right carotid artery and left optic nerve. She was very well in the post operative period and her vision  improved gradually. Histopathological result showed meningioma.

Brain MRI tumour engulf right optic nerve and carotid artery

Brain CT scan after surgery disappear tumour

 12 years old Child had headache and vomiting especially at morning for 14 days. On examination, she had bilateral papilledema with left facial palsy. Brain CT  and MRI scanning showed dilated brain ventricles with no posterior fossa tumor. Ventriculoperitoneal shunt was done. Postoperatively she was free from any headache and vomiting and discharged  home.

Brain CT scan diluted ventricle

 7 months Child had repeated vomiting. Treated as gastroenteritis but not improved. Brain CT scan revealed hydrocephaly. Surgical intervention with ventriculoperitoneal shunt was done. She was very well postoperatively.

Brain CT scan diluted ventricle

30 years old male had a motor cycle accident, presented to emergency unit with coma and bleeding from the right ear. Brain CT scan showed large right temporal extradural hematoma compressing the brain temporal side. Urgent craniotomy was done with evacuation of brain hematoma. He  improved and discharged home in a full consciousness in the 8th postoperative day.

Brain CT scan right temporal extradural hematoma

Right temporal extradural hematoma

Child 5 years old presented with sudden fall on the ground when he was playing outside his home. His family thought that someone hit  their child. On examination he was unconscious with small wound on his vertex, left dilated pupil (very dangerous sign of brain injury). Brain CT scan showed bullet arrested at left temporal lobe with tract hematoma from vertex.

Left sub temporal craniectomy was done, extraction of bullet and evacuation of hematoma. In the 1^st postoperative day, he became conscious but still unable to talk and weakness in the right side. In the 2^nd  postoperative day ,he started  talking with gradual increase in the power of right side. After one month, he was completely returned to normal activity  with free talking  and normal walking.

Brain CT scan site of entrance

Brain CT scan bullet arrested at left temporal

70 years old female had one year history of right sided weakness. Treated as cerebrovascular accident. In last one month she  became unable to speek.  Brain CT scan showed left convexity meningioma. Surgery was done at 29-10-06 with complete excision with dural base, dural graft use to close the dural defect. In the 1^st postoperative day she started to have normal speech. In the 7th postoperative day, she was discharged home with normal gait.

Brain CT scan

left convexity meningioma

Child 7 years old had a mild road traffic accident. No loss of consciousness ,no vomiting. Brain CT scan showed normal. In the next day, the patient was very well, eating and walking normally. Repeated brain CT scan showed same results. After 2 days he started to have headache,  repeated vomiting with attacks of generalized fit, not responding to antiepileptic therapy. On examination, the patient was very risky,  he was unconscious with right dilated pupil (very dangerous sign of brain herniation). Brain CT scan showed very big right intracerebral hematoma with intraventricular haemorrhage. Immediate surgical intervention, right frontal craniotomy with evacuation of  intracerebral hematoma, homeostasis, external ventricular drain to evacuate intraventricular blood. At 2^nd postoperative day ,the right pupil retained to normal size but still  had inability to move eye ball( oculomotor palsy). The external ventricular drain became clear and it was removed.  The patient kept under courses of aggressive physiotherapy.  He was gradually  improved. After one month seemed very well with an ability to talk and walk. 

Brain CT scan 28-10-06

Brain CT scan intracerebral haemorrhage

Brain CT scan

29-10-06

Brain CT scan disappear  intracerebral haemorrhage

17 years old male had Intracranial shell injury, inlet site from right occipital area and arrested at left thalamus causes tract hematoma with intraventricular  haemorrhage. on arrival to the  causality he was  unconscious with  pinpoint pupils and left side weakness .

Operated on for evacuation of intracerebral hematoma, removal of bone pieces with external ventricular drain. He was improved  postoperatively.

 5th day, the Patient developed repeated vomiting   because of blocking of the external shunt with clot.  and shunt revision was done.

9th day started to develop complications, he was feverish with neck stiffness and loss of consciousness. Removal of the external drain and cover with powerful antibiotics. The patient gradually  improved and he became conscious .on the 33rd day he discharged home .

After one year he was speech difficulty and spastic limbs. Brain CT scan showed hydrocephaly with periventicular oedema. frontal ventriculoperitoneal shunt was done. In the postoperative day, he was able to  speak frankly with normal gait.

Brain CT scan sequences

Shell entrance site

Shell arrested site

ventricular drain disappear intraventricular haemorrhage

after 3 month Brain CT scan show diluted ventricules

Intraventricular hemorrhage

Postop. remove of depress seg. with ventricular drain

Removable ventricular drain

frontal vp shunt

33 years old male had 4 months history of headache with vision deterioration, and  hearing loss in the left ear. On examination, bilateral papilledema with left sided facial palsy and absent left corneal reflex . Brain CT and MRI scan showed cerebellopontine angle tumor. Surgery was done with left sub occipital approach and debulking was done. On the 1^st postoperative day ,the patient  was very well with no more headache and gradual improvement of his vision. Histopathology result revealed schwannoma (a benign tumor with a very response to gamma knife) ,so he was sent  for gamma knife for removal of ruminant part of the tumor. 

Brain CT scan

Brain MRI

42 years old male had a depressed occipital fracture with injury to the posterior third of the superior sagital sinus. He was presented to causality as severe bleeding from the wound with blindness.  During surgery severe multiple, depressed segments was found causing partial tear to   posterior third of the superior sagital sinus. He received 5 pints of blood within 30 min, removal of bony pieces, dural suturing was done.  In the 4^th  postoperative day ,his vision improved ,so he discharged  home. 

Brain CT scan fracture site

Brain CT scan bone window

30 years old male had ataxic gait with diplopia for several years.  Brain MRI showed herniated cerebellum (chiari syndrome grade 2). Surgical intervention was done with craniectomy of the posterior fossa, removed C1 lamina with incised dura to be closed with patch to give more space for herniated cerebellum to be return back. After surgery, she was dramatically improved. After 3 months , ataxic gait and diplopia disappeared. Then she returned  back to her work.

Brain MRI

cerebellar herniation

Infant 2 months had slow deterioration of consciousness with difficulty feeding.  when she reached hospital,  she was unconscious and dilated right pupil with left sided paralysis. Brain CT scan showed massive right intracerebral hematoma. Urgent craniotomy was done on 16-8-06 to evacuate the hematoma. Within the 1^st postoperative week, she returned to her normal breast feeding and the pupil size became normally reacting to light  but still she was unable to move the right eye ball( oculomotor palsy). At the end of 1^st month, she became very active child with normal movement for both eyes.

Brain CT scan massive right intracerebral hematoma

26 years old female case of severe backache for 4 months not responding to medication. When she visited my private clinic, she was severely ill with severe tenderness at dorsolumber region. She had rapid response to steroid. Dorsolumber MRI showed extradural hyperintese lesion extend from D11-D12. Dorsal laminectomy with complete excision of mass was done on 15-5-06 histopathology revealed spinal cord lymphoma. she was sent for chemotherapy. Frequent postoperative MRI showed complete resolution of the mass.

MRI extradural hyperintese lesion extend from D11-D12

11-1-07  MRI complete resolution

37 years old male Suffered from backache and un ability to walk. lumbosacral MRI showed disc prolapsed at two levels L4-L5,L5-S1.Leminectomy and discectomy was done for two levels. Post operatively, the patient started walking and after two weeks, he joined his job.

MRI disc prolapsed

 L4-L5,L5-S1

Mylography