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
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29-DECEMBER-2010 AMIRA FAHED AL-HAYEK 65 YEARS D4
INTRADURAL MENINGIOMA WITH LEFT BROWN-SEQUARD SYNDROME.
Anamnesis
The patient
came to the clinic 20-December-2010 complaining
of LBP for 8 years with bilateral sciatica for 3
years with exacerbation the last month more to
the right, down to right L5 territory. MRI
lumbar spine performed 14-December-2010 showing
bulge L2-3, L4-5 and L5-S1. The patient has
osteoporosis. She is a known diabetic and with
arterial hypertension.
On
examination: The patient is walking with
help, limping with exaggerated scoliotic stance.
The patient has analgesia 20 cm above the
umbilicus right side. She has weak dorsiflexion
both feet more weak in the left 3/5. The
right quadriceps femoris is 4/5. SLRS was 70
degrees in the right with pain. She has effusion
both knees.
The
patient was sent for investigation, which showed
a mass intradural compressing the spinal cord at
D4 level. MRI both knees showed effusion of the
knees with severe degenerative changes and tear
menisci. CRP was 10.9 mg/L. RF 26.3U/ml,
ESR =75 mm/h, Uric acid 7.9.
Laminectomy of D4 was performed with partial of
D3 and D5 with the guidance of
image-intensifier. IOM ISIS HighLine was used
with dorsal tumor protocol. The epidural fat was
absent at the tumor localization. The dura was
opened over the tumor and the incision was
extended to see to upper and lower pole of the
tumor. The tumor was with poor vascularity and
it was separated from the compressed spinal cord
by arachnoid membrane. The matrix was at the
incision location. The tumor was totally removed
and the dura was coagulated at the matrix site
and the arachnoid with tumor dirt was removed to
lessen future recurrence.
Routine
closure of the wound. Smooth postoperative
recovery with normalization of the power of both
lower limbs.
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Comments
Brown-Sequard syndrome is the
manifestation of the involvement of the half of
the spinal cord in axial section, but in the
life and practice, it comes with atypical
picture with different manifestations, depending
upon the character of mass effect.
Usually meningiomas are with high
vascularity in other locations, but in the spinal cord it
seems that they are poor in vascularity.
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 .
