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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01-SEPTEMBER-2008 ISSA AL-HAJ HASAN AYOUB 57 YEARS
RECURRENT GLIOBLASTOMA MULTIFORME BOTH CEREBRAL HEMISPHERES MORE THE LEFT.
The patient was operated by
me 9 months
ago for very aggressive glioblastoma
multiforme left fronto-temporo-parietal lobes
with involvement of the left insula and internal
capsule. Gliadel 16 wafers were inserted at that
time, that could slow down the aggressive
progression and binging it to halt for 8 months.
Serial MRIs were performed
every 2 months and confirmed the stabilization
of the process.
The last month, the patient
started to show deterioration with swallowing
difficulty and the verbal response and talking
MRI of the brain performed
18-August-2008 confirmed the presence of wide-spread
recurrence of the tumor over the cerebral
hemispheres mainly locally and in the
contralateral Sylvian cistern.
Considering that the patient
underwent radiotherapy with maximum permitted
dose, the option of boostering dose is omitted.
Taking into consideration that the patient
showed good response to the previously inserted
Gliadel wafers, the family agreed to give him
approach from the left side, small craniotomy
was performed. That part which was occupying the
left temporal fossa was removed and the left PCA
and brain-stem were visible and the CSF came out
freely from the interpedincular cistern. The
choroid plexus of the left inferior horn was
seen and the inferior horn was inspected. The
CSF pathways were intentionally created to make
doors for gliadel to reach the contralateral
Some parts of the tumor were
sent to histological studies and some wafers,
which were inserted at the first surgery were
still present at their site. They were removed
and sent for histological studies.
16 Gliadel wafers were
inserted near the brain stem and at the left
inferior horn and the tumor bed and posteriorly
under the temporo-occipital lobes with special
attention to the vein of Labbe.
Routine closure of the wound
and smooth postoperative recovery.
The patient had very
aggressive glioblastoma multiforme 9 months ago
and Gliadel could bring to halt the aggressive
nature of the lesion.
It is early to predict the
behavior of the tumor with next Gliadel
implantation. Time will tell.
The microscopic examination
revealed a glial tumor showing extensive
necrosis, edema and fibrin thrombosis of blood
vessels and mixed inflammatory cell infiltrate.
Areas showing palisading of tumor cells with
moderate degree of anaplasia with focal place
reveal increased mitotic figures more than 16
per 10HPF. The membranous fragments noted
grossly reveal mostly fibrin in addition to a
minor ropy and delicate component and patchy
chronic inflammatory cell infiltrate.
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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 .