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24-DECEMBER-2009  MUHAMED SHAABAN AL-KHALILY  21 YEARS  GIANT CONVEXITAL MENINGIOMA LEFT PARIETO-OCCIPITAL REGION.

Please! wait for 3-5 min till the video start to load. It depends upon the internet connection.

Anamnesis:

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The patient was operated by me 22-January-2004 for huge meningioma of the dorsal spine at D6  right side. The patient was neurologically free after the operation and the last MRI of the dorsal spine was free performed 21-June-2008 with mild kyphosis at this level.

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The patient then came to the clinic 20-December-2009 complaining of headache for 2 months in the left occipital region. The headache was progressive with nausea and awakening him during night. The last 2 days he progressed atonic attacks .

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MRI brain done 10-December-2009 showing giant convexital meningioma in the left occipito-parietal region.

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On examination: the patient is neurologically free.

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Osteoplastic wide craniotomy of the left occipito-parietal region. The bone flap was involved with the tumor, for what it was removed and sent for boiling in 125 degrees Celsius for 15 min in the autoclave. The tumor had very wide matrix and the healthy dura was incised parallel to the edge of the tumorous dura. The tumor was rich in vascularity and it was coagulated and debulked. The tumor was sent for fresh frozen section, which confirmed meningiomatous nature of the tumor. The cleavage between the tumor and the surrounding brain was identified and sharp dissection was proceeded until the tumor was radically removed. All the running veins and arterioles were respected and preserved until the end of resection.  After meticulous heamostasis, BloodSTOP ix was used several times and it was found that it was a bad option, because it seems it trigger bleeding and it was impossible to be sure what is going on under its layer.  It even triggered arterial bleeding, for what it was washed out and another trail was performed to see what is going on. The same disadvantages repeated and the material was cleaned and surgicel was applied in the tumor bed, which showed good control and dry field.

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Lyodura was replaced of the removed tumorous dura and water-tight closure was achieved. The treated bone flap was returned to its place and fixed with 9 points. Routine closure of the wound with Ready-Vac inserted under the scalp.

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The patient was extubated and sent to the ICU without any neurological deficit.

Control CT-scan 6 hour after surgery.


Comments

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BloodSTOP ix  is a bad option for such a surgery and it seems it triggers bleeding even from previously controlled sites. It has many disadvantages, that it is better to avoid using this material. Surgicel is more superior and lacking of such disadvantages.

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Even the tumor was of giant size, the patient was neurologically free before and after the surgery.

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The patient has meningiomatosis, for what he was operated 5 years ago for spinal meningioma and now for supratentorial meningioma.


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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 .

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