Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity. For reference to the academic and theoretical part, you are welcome to visit
Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses
Multigen RF lesion generator .
20-FEBRUARY-2010 HAFEZ ISSA AL-TAMIMY 53 YEARS
GIANT LEFT OLFACTORY GROOVE MENINGIOMA WITH COMPRESSION OF THE OPTIC NERVES AND
ENGULFING BOTH ICAa.
Please! wait for 3-5 min till the
video start to load. It depends upon the internet
brother of the patient is a doctor came
13-February-2010 telling that the patient start
to complain of signs of frontal lobe syndrome,
for more than a year for what he lost his job
and he was treated by psychiatrists.
MRI of the brain
done the same day showing huge olfactory groove
meningioma, occupying the entire anterior fossa
more the left with involvement of the optic
nerves and both carotids inside the tumor with
possible involvement of both cavernous sinuses.
Repeat MRI of the
brain with contrast and MRA was requested and
done the next day.
the day before surgery: the patient
is alert , but with signs of frontal lobe
syndrome with anosmia and visual disturbances of
the left eye. He has weak both upper limbs both
sides more the right.
craniotomy with reflection of the flap to the
right ear. The dura was opened parallel to the
inferior edge of bony defect, which was
violating the frontal sinuses, which were
managed accordingly. The anterior border of the
tumor bed was attacked from the left and
the matrix of the tumor was involving the left
olfactory groove and the planum sphenoidale.
Piece-meal resection of the tumor was started
and it was rubbery in consistency and bony hard
spheroid masses about 12X12 mm were found inside
the tumor. Inspection for the left
olfactory tract revealed negative results. It
was absent and completely replaced by the tumor.
After completion the resection of the
antechiasmal part, dissection of the tumor off
the Aa and the optic chiasm and nerves was
succeeded. That part which was occupying the
suprasellar region was removed and both optic
nerves were free of the tumor and it was
possible to see the pituitary stalk. The tumor
parts which were invading the Sylvain cisterns
and engulfing the supraclinoid both ICAa
were removed and it was possible to see the ICAa
and the bifurcation to A1 and M1 both sides. The
cavernous sinuses were not involved with the
tumor. Total resection was achieved. The right
olfactory bulb and tract were preserved
Routine closure of the wound.
recovery, and the patient was sent to the ICU.
Before the surgery
in such a case, when the tumor reach a giant
size, it is difficult to know exactly which
structures are involved in the tumor matrix. In
this case the cavernous sinuses were suspected
to be involved with the tumor process, which was
negative during the surgery.
The total resection
is not the main aim of surgery, but when it is
feasible, it is a welcome result.
function was lost before surgery for unknown
period, and preservation of the right olfactory
tract will not bring olfaction. Preserving this
anatomical structure, means from one side that
the surgeon was delicately reacting with the
neural tissues, which means minimal surgical
trauma, and from the another hand, olfaction
could return, which is highly unexpected.
For more information
about olfactory groove meningiomas, please
Notice: Not all operative activities
can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also
escaped from the plan .