www.neurosurgery.tv 
   

neurophysiology.ws
neurosurgery.tv
e-neuroradiology.com
onconeurosurgery.com
craniopharyngiomas.com
pituitaryadenoma.net
meningiomas.org
neuro.science

Surgical group is like a football team.

 
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  neurosurgery.tv

Functional Neurosurgery
functionalneuro.surgery
Functionalneurosurgery.net

IOM Sites
iomonitoring.org
operativemonitoring.com

Neurosurgical Sites
cns-online.com
cns.surgery
cns.today
e-neurosurgery.com
neurosurgery.ag
neurosurgery.bz
neurosurgery.co
neurosurgery.cz
neurosurgery.gallery
neurosurgeryvideo.gallery
neurosurgicalvideo.gallery
neurosurgery.guru
neurosurgery.me
neurosurgery.mx
neurosurgery.photos
neurosurgery.tips
neurosurgery.tw
neurosurgeryspine.org
skullbase.surgery

Neurosurgical Encyclopedia
neurosurgicalencyclopedia.com
neurosurgicalencyclopedia.net
neurosurgicalencyclopedia.org

Neurooncological Sites
acousticschwannoma.com
craniopharyngiomas.com
craniopharyngiomas.net
ependymomas.com
ependymomas.net
glioma.co
gliomas.info
meningiomas.info
meningiomas.org
neurooncology.me
neurooncology.tv
neurooncology.ws
onconeurosurgery.com
pinealomas.com
pituitaryadenomas.com
pituitaryadenoma.net
schwannomas.com

Neuroanatomical Sites
diencephalon.org
humanneuroanatomy.com
medullaoblongata.info
mesencephalon.org
microneuroanatomy.com

Neuroanesthesia Sites
neuroanesthesia.info

Neuroendocrinologiacl Site
humanneuroendocrinology.com

Neurobiological Sites
humanneurobiology.com

Neurohistopathological
neurorhistopathology.com

Neuro ICU Site
neuroicu.info

Neuroophthalmological
neuroophthalmology.org

Neurophysiological Sites
humanneurophysiology.com
neurophysiology.ws

Neuroradiological Sites
neuroradiology.ws

NeuroSience Sites
neuro.science

Neurovascular Sites
vascularneurosurgery.com
vascularneurosurgery.net

Personal Sites
cns.clinic
cnsclinic.org
munirelias.com

Spine Surgery Sites
spine.surgery
spinesurgeries.org
spondylolisthesis.info
paraplegia.ws

Stem Cell Therapy Site
neurostemcell.com


Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses


Multigen RF lesion generator .

 

04-AUGUST-2009  ABDEL SALAM HASAN MUHAMED  15 YEARS  POST-TRAUMATIC HUGE BONY DEFECT IN THE LEFT FRONTO-TEMPORAL REGION.

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

Anamnesis:

bullet

The patient came to the clinic 24-September-2008 after suffering severe head injury 11-July-2008 and was unconscious for more than 2 weeks. The patient underwent decompressive craniotomy in the left fronto-temporal region and the bone flap was preserved in the refrigerator.

bullet

Serial CT-scans were performed demonstrating the huge prolapse of the brain from the bone defect.

bullet

On examination: the patient had dense right sided plegia with hypalgesia of the right side of the body with spastic pattern. He could walk with aid with speech disturbances.

bullet

The father was advised not to undergo surgery for closing the bone defect since the brain still prolapsing with severe degree and there is no control of epilepsy, for what he was receiving Convulex 300 mg tid.

bullet

The patient was given medications to decrease the brain prolapse and to rescue the still surviving neural tissues in the massive gliotic left cerebral hemisphere.

bullet

The patient was seen 05-October-2008 with MRI of the brain demonstrating the above mentioned data.

bullet

The patient then came 07-July-2009 with slight improvement of the right plegia-paresis. The patient is left handed and the speech normalized. There is no prolapse of the brain and the bone defect is palpable with brain is lax transmitting the cardio-pulmonary pulsation.

bullet

The patient was admitted 10 days ago, but he had flue for what his operation was postponed.

bullet

The removed bone was requested from the other hospital and inspected and was autoclaved in 134 degrees for 15 min.

bullet

The old incision over the left fronto-temporal region was refreshed and the dura was separated from the the scalp. No CSF leak was noted. The left lateral ventricle was punctured to rule out the presence of cystic cavities with any brownish liquid collection. A clear CSF came out and the brain came more relax.  The bone graft was another time inspected and cleaned meticulously from debris  and it was fitting for the 90% of the posterior area of the defect. There were chips of his bones in the lower temporal region not fitting with construct, which were removed and there were inserted anterior to fixed bone graft, where there is still linear bony defect.  This act helped in 2 points: 1. The removed bony elements helped to achieve more fitting of the graft. 2. In case of postoperative complication, the only suspected triggering factor will be only the graft, which was preserved in another hospital.

bullet

Routine closure of the wound and smooth postoperative recovery.


Comments

bullet

In case that decompressive laminectomy was performed, it is better to wait until the brain becoming relax and not protruding through the bone defect. It needs at least 6-12 months depending at the severity of injury and the presence of other triggering factors and the epileptic activity.

bullet

The methods of bone preservation are deferent and in this case freezing the bone was performed. The shape and texture of the bone was acceptable for what it was used to cover the bone defect. To avoid possible contamination, it is preferable to autoclave the bone graft at 134 degrees for 15 min.

bullet

In skull X-rays the bone usually is translucent and becoming visible several months after surgery.

bullet

Surge of calcium could have place in the postoperative period, for what Ca level must be recorded for several days.


Back Up!

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 .

     

  

[2009] [CNS CLINIC - NEUROSURGERY - JORDAN]. All rights reserved