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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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07. 08-NOVEMBER-2007
NASER MAHMOUD AL-HAMAWY 39 YEARS CSF LEAK AFTER
THE SECOND OPERATION PERFORMED 01-NOVEMBER-2007.
Anamnesis
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The patient was operated by
me 01-November-2007
for remnant of the tumor . The patient was doing
well and the wound was clean, until the third
postoperative day after 2 days of ambulation,
suddenly progressed CSF leak. The patient was
put in mannitol without help. The next day
diamox was administered 4 times a day and
the third day Lasix 40 mg twice daily with
putting the patient in the head down position
with strict bed rest, without results.
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Considering the huge amount
of CSF leak with these measurements, it was
decided to explore the wound. |
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Debridement of all the old
scarous tissues was performed. and the dura was
seen open at the middle of the field, about 7 mm
length. The stitches at this defect were
slipped. It was possible to see the spinal cord
which regained a normal appearance running
inside the dura with good pulsation of the
xanthochromic CSF. |
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The dura was closed tightly
and check with elevation of the head and
Valsalva maneuver, showed no CSF leak. For more
security, a piece of muscle with histocryl glue
was impacted over the the upper part of the
dural incision. |
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Tight layer by layer closure
of the wound with water-tight closure of all
layers. |
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Smooth postoperative
recovery. |
Comments:
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CSF leak is one of the usual
complications after spinal or cranial surgeries.
Usually conservative treatment can resolve the
problem in more than 70% of cases. If the CSF
fail to show decline in its production and leak,
it is better to explore the wound and close the
defect. 4 Zero nylon was used and hermetic
closure was achieved and further aid with muscle
and glue were used for assurance of CSF leak
closure. |
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The dural defect was 7 mm
length and it was unlikely, that conservative
measures will resolve the problem. |
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It was striking, that the
spinal cord regained normal appearance in
comparison to the previous surgery. |
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