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01-NOVEMBER-2009 NASER MAHMOUD AL-HAMAWI 41 YEARS
RECURRENT TERATOMA OF THE SPINAL CORD BEHIND D12 AND L1 BODY.
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The deformed conus medullaris after this surgery
The patient was operated by
08-November-2007 for recurrent teratoma
behind D12 and L1 using Inomed IOM and was
operated three times for that. The patient then
came several times and showed improvement in
several aspects. Several check MRI showed no
The patient then came
11-March-2009 complaining that his condition is
deteriorating and on examination the sensory
deficit was more wide spread then during
29-November-2007 with micturiton and defecation
MRI lumbar spine performed
16-March-2009 showing huge recurrence of the
tumor at the previous location.
The patient disappeared and
came back 17-October-2009 with new MRI showing
enlargement of the tumor and deterioration of
his condition. The planterflexion of the right
foot became 2/5.
Refreshment of the old wound
and dissection was started from above down.
After identifying the spinal cord the plane
between it the dura was bisected and followed
down until the lower edge of the tumor mass. The
posterior aspect of the spinal cord was not
functioning and it was scarrous, for what it was
opened about 4 cm at its medial projection over
the tumor which came easily and was removed in
several pieces. Water irrigation under pressure
was applied to clean the cavity which actually
was entirely opened from behind. Attempt to
remove the inside the cavity wall confirmed that
it was a functioning neural tissue, for what it
was decided not to violate it so as not to cause
further neurological deficit to the patient. So
as to protract the period of possible next
recurrence an artificial graft was used to close
the dural defect to give more ample to the tumor
location. The graft was water-tightly closed.
Routine closure of the wound
and smooth postoperative recovery.
Epidermoid or teratomas are
benign in nature but sometimes it is difficult
to remove them totally and subtotal resection is
the preferred solution so as to avoid damage to
the functioning neural tissues.
Using Inomed ISIS is the
integral part to such operation, because without
using this technology, the surgeon cannot
evaluate what he is dissecting and what he must
leave behind, respecting during that the
functionally important tissues.
The patient was sent to
perform check MRI 07-November-2009 and he got
anaphylactic shock after contrast injection
(MultiHans - Bracco) after what he was
resuscitated and was treated accordingly.
MRI performed 6 days after surgery confirming practical
total removal of the lesion.
contrast agents used in MRI investigations.
The patient performed more
than 10 times over the years MRI investigations
using contrast media without complications. The
center was using Magnovist. At this time he was
given Multihans and this could cost to him his
life due to rapid allergic anaphylactic shock
which was treated immediately.