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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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01. 04-AUGUST-2007
SALAMAH FARAJ BAHADY 50 YEARS
INTRADURAL EXTRAMEDULLARY MENINGIOMA D2-3 WITH MATRIX IN
THE RIGHT DENTATE LIGAMENT REGION.
Anamnesis
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The patient came to the
clinic 30-July-2007 complaining of inability to
walk for 7 months with rapid deterioration,
starting from the right the the left lower
limb within one month. She is in wheelchair for
7 months. |
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MRI performed 11-March-2007
showed a huge meningioma at D2-3 level. |
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On examination: the patient
had complete spastic paraplegia with severe
rigidity and scissoring of the lower limbs with
exaggerated deep reflexes and bilateral Babinski
and massive clonus and spastic rigidity, making
the limbs unable to put them apart. |
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The patient claim that she
can feel the lower limbs, but position sense is
impaired and she could not know, which toe of
which foot the examiner is pinching. Defecation
and micturition was normal, as she claimed, but
she was in wet diaper and she was from Yemen and
it was hard to tell the actual condition. |
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The patient was sent for
another MRI, which confirmed the presence of
large meningioma at the mentioned levels. |
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Laminectomy of D2-3 and
flavotomy of D1-2 and D3-4 was performed. The
dura was opened from the right side. The tumor
was rubbery dense and the running roots of D2
and D3 were dissected of the tumor. Piecemeal
resection of the tumor was started and
preservation of the rootlets and roots was
achieved. |
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The matrix of the tumor was
originating from the right dentate ligament,
which was coagulated and bisected. Total
resection of the tumor was achieved and dural
defect and the most involved part was stitched
to prevent possible CSF leak. |
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Water-tight closure of the
dura with routine closure of the wound. |
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Smooth postoperative
recovery. The neurologic deficit still the same. |
Comments:
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The patient is complete
paraplegia for more than 7 months with
scissoring and spastic rigidity of the lower
limbs. These data suggest poor postoperative
recovery. The patient is young and she is not
systematically impaired with diseases such as
diabetes mellitus, which could raised the hope
for certain recovery. Time will tell the result. |
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The patient could be sent for
urodynamic studies for bladder function
evaluation, but the bladder during examination
was full, denoting overflow incontinence, but
for ethical and time factors and the idea that
it will not change the strategy of the
operation, this part was ignored.
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