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


So as to expose the D7-9 postganglionic roots,  it is necessary to drill the lower part of the costotransvese articulation and the most proximal part of the lower edge of the rib. The root is running vertically and it is usually more easy to find. and isolate.  These roots must be checked for full function, using direct stimulation after modifying the mode of anesthesia. This must be done for double check-up of the preoperative ECS.

The number of the exposed postganglionic roots is governed by the number of harvested grafts. In this case only 6 grafts were obtained. As mentioned in other articles, the donors are not acceptable, since the rejection will be escaped and in case of rejection the graft, will be useless and fade away.




The dorsal roots are easy to find and isolate. They usually becoming under visual control, after drilling the lower part of the costo-transverse articulation and first 10-15 mm of the proximal lower edge of the rib. Some space is needed to to perform the stitching of the anastamosis. The extrapleural fat is usually transmitting the cardio-pulmonary pulsation.

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