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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14-APRIL-2012 MUHAMED MAHMOUD AL-AGHA
57 YEARS FILUM MEDULLARE EPENDYMOMA WITH CAUDA EQUINA INVOLVEMENT
FROM D12 DOWN TO L2 WITH SEVERE PARAPARESIS AND CAUDA EQUINA
patient came to the clinic 10-April-2012
complaining of LBP for one year with bilateral
sciatica for 4 months more tot eh left not
reaching below the knees. The patient has
difficult micturition for 4 months and difficult
walking for 10 days. The patient had 2 episodes
of convulsions the first 3 years ago and the
second 18 months ago, for what he is receiving
Depakine 500 twice daily.
MRI lumbar spine performed 05-April-2012
showing intradural tumor behind D12-L2 with
involvement of the spinal cord and the cauda
examination, the patient
shuffling gait. Romberg position was stable. He
has intention tremor both hands. SLRS was 70
degrees due to weakness both sides. The knee
jerk was present in the left side with possible
Babinski in the right side, but without clonus.
There is profound weak dorsi and planterflexion
both feet -3/5. Adduction of the knees 4/5,
abduction 3/5. The right quadriceps muscle power
was 4/5 and the left -4/5. There is hypalgesia
around the anal region.
patient was sent for MRI of the brain , cervical
and dorsal spine, which were done 10-April-2012, confirming the presence
of moderate ventricular dilatation above the
tentorium, holding the suspicion of NPH. The
above mentioned tumor is the same as before.
Laminectomy of D12, L1 and L2
under the image-intensifier. There is
sacralaization of L5. The dura was opened from
the upper border of the tumor down to its lower
border. The exophytic parts of the tumor which
looks as ependymoma was removed. Using ISIS
Inomed HighLine neuronavigation, the
intermingled roots in side the tumor were
preserved. The spinal cord was infiltrated by
the tumor diffusely. It was studied and decision
to leave it was appreciated. Some segments of
the cauda equina was totally freed from the
tumor. Other segments were adherent with the
tumor dirt which was maximally removed without
injuring the running roots. After resection of
the tumor check of spinal cord function was
checked and it was functioning in both sides
with all running roots.
closure of the wound. Smooth postoperative
recovery. The power of the lower limbs improved
more in the left side..
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The patient has a tumor
that at places it was diffusely invading the
spinal cord and at other places it has an
exophytic growth. All the exophytic growth was
The final histologic result was ependymoma. For
more information about this pathology 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 .