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 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.
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02.
03-JULY-2007 MUSTAFA UMAR AL-RAMAHI 2 YEARS
RIGHT HEMISPHERIC GIANT PILOCYTIC ASTROCYTOMA WITH
MASSIVE INTRAVENTRICULAR EXTENSION
Anamnesis
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The patient came to
Al-Shmaisani hospital 01-July-2007 with a
history of drowsiness for a month and left sided
hemiparesis for one week. |
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MRI performed the same day showed
a pilocytic astrocytoma right cerebral hemisphere
under the sensorimotor strip extending down to the
right lateral ventricle and pushing the brainstem
down and the third ventricle to the other side. It
had small cystic component located anteriorly. |
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In supine position with the head
rotated to the left, a wide osteoplastic frontal
craniotomy was performed and transcortical approach
was achieved most anteriorly to avoid the possible
shifting of the sensory motor strip. |
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The cystic component was
evacuated and the solid component was removed by
piece-meal resection. It was pinkish in color and
variable consistency. It had arterial feeders and
pathologic veins, which were coagulated A proper
cleavage was found and followed. The anterior horn
was pushed laterally and the the head of the caudate
nucleus was pushed anteriorly. It was possible to
see the flax cerebri and the running inferiorly the
anterior cerebral artery. A small hole was seen at
the location of the III ventricle. The posterior
horn was inspected and all the remnants of the tumor
were removed. |
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After the removal of the tumor
the supposed to be far from the motor strip incision
became closer to this area indicating, that it was
pushed anteriorly. |
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Routine closure of the wound with
smooth postoperative recovery. |
Comments:
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The tumor was located under
the motor and sensory strip and interhemispheric
approach will cause permanent damage to them,
for what anterior transcortical approach was
planned to avoid this important area and at the
time to gain direct visual access to the
extending down to the posterior horn part of the
tumor and the part which was transgessering the
subfalcine region. |
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For more details about
pilocytic astrocytomas,
please click here! |
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The final histologic result
was that of ependymoma of intermediate grade with
sites of cystic and necrotic degeneration. There
was occasional mitotic activity and the
proliferation index (ki-67 approaches 15% in
areas). GFAP was positive For
more details about ependymomas please refer to
ependymomas.info. |
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| Immediate postoperative
CT-scan confirming radical resection of the
mass. |
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