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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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2. 15-JANUARY-2007
AYESHA KHALEEL BADAWI 54 YEARS RECALCITRANT
LEFT TRIGEMINAL NEURALGIA AFTER FAILED GAMMA-KNIFE
TREATMENT.
Anamnesis
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The patient came
03-September-2003 complaining of left
trigeminal neuralgia for 3 years. She was under
treatment with neurontine 300 mg 5 times a
day with Rivotril 0.5 mg 4 times a day.
MRI performed at that time ruled out the
presence of other pathologic processes. |
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The patient, then came
06-January-2007 with agonizing pain, claiming
that, she underwent Gamma-knife treatment for
neuralgia 24-October-2003 without any benefit. |
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The patient in mega-doses of
neurotop, neurontine, Rivotril, xanax and
lexotanil. Despite that, she was in agonizing
pain. The patient came urging for surgery. |
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In setting position, left
retromastoid approach was performed and the
sigmoid sinus was torn during that, and it was
repaired by nylon 6 zero. |
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The vein of Dendy was
coagulated and the arachnoid around the left
trigeminal nerve was dissected. The arachnoid in
the lateral part was thick, which could be due
to Gamma-knife effect. The major branch of left
AICA was dissected away from under the trunk of
the trigeminal nerve. Inspection of the veins
was unremarkable. Inspection of one of the
branches of the AICA revealed that, it was
buried in the brainstem under the axilla of the
trigeminal nerve. This part was dissected and
the loop was elevated from the inside tissues of
the proximal part of the nerve and the loop tip
was calcified and turning back to emerge
anterior to the trigeminal nerve and then take
it's normal course in the brain stem. This loop
jumped away anterior to the emergence of the
trigeminal nerve. |
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Using muscle coated around
the nerve and surgicele between the muscle and
the loop and Teflon, separation of the nerve was
secured off the loop. |
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Smooth postoperative recovery
and immediate postoperative disappearance of the
trigeminal neuralgia. No complications could be
noticed. |
Comments:
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The golden standard in
treatment of neuralgia in young aged patients
remain microvascular decompression of the
affected trigeminal nerve. |
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Gamma-knife have suspicious
role in trigeminal neuralgia treatment. |
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Ballooning and radiofrequency
thermodistruction have high recurrence rate. |
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For further theoretical
background, please click
here! |
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