NEWS

January/06/2007

Surgical treatment in paraplegia survey:

Cross-anastamosis in paraplegia below D9 started to give results. The last documented case operated 1 year ago in a patient from Israel came to the clinic 3 weeks ago. ECS and EMG performed showed that there is starting innervation of Th 11 and 12. The patient's lower limbs muscles became bulky and he could contract the lower abdominal muscles and some movements in the pelvic girdle. Crude sensation descended down to the inguinal level both sides. If you are more interested in this topic, click here!

March/08/2007

Tuberculosis of the spine

In the last 2 years the incidence of tuberculosis of the spinal column is becoming more frequent and having different clinico-morphologic picture. This phenomenon is alarming sign as the residual of the use of dirty bombs and several radioactive materials in the surrounding dirty wars in the region. For demonstration click here! and here!

20-AUGUST-2007

SIEMENS Digital C-arm is implemented and functioning in the Shmaisani hospital.

30-AUGUST-2007

The Inomed ISIS Highline neurophysiologic navigation system start to work at the operating room.

02. 01-NOVEMBER-2007 NASER MAHMOUD AL-HAMAWY 39 YEARS SECOND RECURRENCE OF CONUS MEDULLARIS DERMOID CYST WITH FAILED SACRAL FUNCTIONS. REOPERATION AFTER CHECK POSTOPERATIVE MRI.

Anamnesis

	The patient was operated by me 29-October-2007. The patient showed dramatic postoperative improvement of the power of the lower limbs and sensation don to both feet except for numbness and hypalgesia of the left S1 root.
	Check MRI performed 31-October-2007 confirming the presence of residual of the lower part of the tumor.
	Despite the fact, that the patient showed dramatic improvement, it was decided to reoperate him, as soon as possible, before scar mask the performed surgery 2 days ago.
	Reopening of the wound and 20 mm of the dura was dissected down and the lower component of the tumor was brought to the field.
	Using Inomed ISIS with DNS and EMG of the lower limbs and the sphincter ani both sides, bipolar stimulation was performed over the capsule, where the incision planned to perform. No EMG activity was recorded.
	The sac was opened and the tumor material was removed and the previously emptied cavity was dissected, so as to have one cavity.
	The upper end of these cavities was connected with tip of the pathological conus medullaris, which showed more or less acceptable neural structure, for what it was decided not to remove the reactionary arachnoidal structures in the hope that they contain some fibers, responsible for the sacral functions.
	Water-tight closure of the dura and the wound.
	Smooth postoperative recovery, with further improvement of the power of the left foot.

Comments:

	It is the third operation for the same level with scars masking the normal anatomy. Without the guidance of the IOM it was impossible to know what exactly the importance of the abnormally localized neural structures.
	It was evident that the motor functions of L-2-3-4 and L5 were showing improvement in the records, because of the decompression.
	It was sad that the BCR, anal-M-wave, MEP and SEP after pudendal stimulation and the D-wave did not show any signs of the sacral functions before and after the surgery.
	Considering that, the surgery was performed in abnormal anatomy, MRI was performed and it showed the presence of another compartment of the tumor, mandating the reoperation to bring the surgery for its maximum morphological and functional result.
	From this case and many others, intraoperative real-time MRI with fMRI guided surgery is a must and we hope to install it in the near future.