09-November-2004

www.neurosurgery.tv

neurosurgery.cc
neurophysiology.ws
neurosurgery.fr
e-neuroradiology.com
onconeurosurgery.com
craniopharyngiomas.com
pituitaryadenoma.net
meningiomas.org
munir.ws

Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity. For reference to the academic and theoretical part, you are welcome to visit neurosurgery.fr

PART - 1

A Syrian gentleman 58 years came to the clinic 05-11-2004 with complaining of right oculomotor plegia. He was referred as a case of meningioma and he was sent for more MRI and MRA investigations, which confirmed the diagnosis of right posterior clinoid meningioma. The patient start to complain of Diplopea for 2 days then the last 2 weeks progressed complete right oculomotor plegia. The patient was admitted to Al-Shmaisani hospital 09-11-2004 and was operated the same day.

The supraclinoid part of right ICA is invaded by the tumor and M1 and A1 also. The mass compressing the right oculomotor nerve, but not invading it and the Liliquist membrane was intact.

Third postoperative day the infarction established and clexane 40 mg was given the next postoperative day to show some petechial haemorrhages, for what it was lowered to 20 mg. Notice radical resection of the tumor.

The fist operative day CT-scan showed no infarction, but the second operative day, the patient progressed massive right occipital lobe infarction, indicating that spasm of the right posterior cerebral artery took place.

Notice the left A1 is absent, which makes the surgery at the lesion more hazardous. The right ICA is elevated at the bifurcation and posterior communicating artery is shifted downward.

Brain MRI & MRA

done 2 days before surgery, showing posterior clinoid meningioma growing parasellar directions with involvement of the right ICA, M1 and M2. The right optic nerve was pushed antero-medially and the right posterior communicating artery was pushed inferior and the compressed oculomotor nerve inferiorly was not involved. Notice that the left A1 was missing, making the surgical task more challenging. The anterior parts of the tumor was invading the right ICA and adherent to its wall and the anterior choroidal artery was pushed medial. CT-scan done the same postoperative day was uneventful, but the second postoperative day it showed massive infarction of the right occipital lobe due to remote spasm of the right posterior cerebral artery. The patient was given clexane 40 mg once and the third postoperative CT-scan showed petechial haemorrhages, for what clexane was decreased to 20 mg daily.