www.neurosurgery.tv 
   

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

Dr. Ali Al-Bayyati and Dr. Munir Elias

 
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 .

19-OCTOBER-2011  ALFATEH HAMAD ALNEEL  73 YEARS  HUGE EXTRUDED DISC C3-4, 4-5, 5-6 AND C6-7 WITH SEVERE SPINAL CORD COMPRESSION.

Anamnesis

bullet

The patient came to the clinic 12-October-2011 complaining of unsteady gait for 15 months and fainting attacks.

bullet

On examination: Romberg position is stable. There is fine horizontal nystagmus when looking to both sides. There is weak grip both hands 4/5, extension right hand 3/5, left hand 4/5, and both triceps muscles -4/5. Weak both lower limbs -4/5 all muscles, except the left foot dorsi and planterflexion, which is 3/5. There is hypalgesia right hand and ulnar side right upper limb and hypalgesia both lower limbs. Hoffmann positive both sides more pronounced in the left side.

bullet

MRI brain performed 12-October-2011 showing dilated ventricle with small scattered lacunar infarctions both cerebral hemisphere, compatible with age. MRI cervical spine 11-October-2011 showing huge PCD C3-4, 4-5 and 5-6 with lesser at the C6-7 with malacia of the spinal cord at these levels with severe cervical canal stenosis at these levels. OPLL having place, which must be taken into consideration and corrected  .

bullet

In supine position with Hallo traction 5 Kg applied, in neck neutral position, discectomy C3-4, C4-5, and C5-6 was done until the dura was seen all over the entire disc spaces. Fidji cervical cage 15x12x6.9 was inserted to C3-4 disc space with Novabone. Another one 17x12x5.3 was inserted to C4-5. The third 17x12x6.1 was inserted to C5-6. Trinica plate 80 mm 4 level cervical plate was used to fix C3-4-5-6 and C7 using screws 4.2x14 for C3 and C4 and Trinica fixed screws 4.2x16 mm for C5,6 and C7. All the stages of the surgery was done under C-arm guidance.

bullet

Routine closure of the wound.  The patient took 3 hours to recover after what he started to response to verbal command and speak and count, but with dense tetraplegia. The patient then start to move the upper limbs after 5 hours but with the left upper limb weaker than the right. All vital signs were acceptable. The patient could move the right foot at 21.00 P.M.  8 hours after surgery. The patient was transferred to the clinical department.


 

 

 

 

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

 

Comments

bullet

The patient has malacia of the spinal cord at multiple levels and the major compression is anterior, for what anterior decompression is the appropriate option for decompression.

bullet

Posterior decompression will cause complete tetraplegia with respiratory arrest in high percent of cases. ( more than 95%). Anterior decompression could cause transient deterioration as in this case, because the spinal cord is in critical position, even with brilliant surgery.

bullet

The patient got clear deterioration of the left upper and lower limbs and the cause is not understood. If to blame traction, only 5 Kg were applied to the Hallo traction. The traction was applied in neutral position and hyperextension was avoided. We use traction of both shoulders for proper screening of the C6and C7 level. This could be blamed, because there is no measurement for this type of traction. This could cause brachial plexus traction and subsequent traction of the spinal cord. We use very tiny instruments when dissecting the posterior longitudinal from the dura to avoid mechanical compression to the already compressed spinal cord. The extradural part of the operation ran smoothly during surgery.

bullet

It could be that the age of the patient, diabetes mellitus, cardiovascular problems and severe malacia of the spinal cord, all together with minimal traction applied by Hallo and traction of the brachial plexuses, all accumulate to give such deterioration.

bullet

In this case we did not use Inomed ISIS intraoperative monitoring. In the future, in such a case it is mandatory to perform such surgery with this facility, at least to catch the moment and cause of deterioration.

Follow Up

bullet

The patient progressed 26-October-2011 sudden onset hematoma at the operative site three days after starting aspirin 75 mg daily. The patient was taken urgently to the operating room and evacuation of the hematoma was performed and inspection for the carotid was negative. The source of bleeding was due to hypocoagulation. Precautionally, all the suspected small veins were coagulated. The patient was put in ventilator for 2 days until the swelling in the neck to resolve.

bullet

The patient was neurologically improving in the ventilator and he was disconnected and was sent to the ward one day later.

bullet

Four hours after transfer, the patient showed difficulty in breathing and the patient progressed massive left sided pulmonary embolism. He was urgently taken to the ICU and during transfer, "we are talking about several seconds", he progressed bilateral pulmonary embolism and all efforts for CPR failed and brain death was declared 4.20 P.M.  29-October-2011.

Conclusion

bullet

The patient has high index of postoperative complications. In the future, it is better not to operate such a case, unless the family insist to operate such a case and the family must be warned about this high index of mortality.

bullet

Short neck and difficult intubation played negative role in all stages of the surgeries and resuscitation, During the second surgery, it was impossible to insert the endotrachial tube, instead, the laryngeal mask was used, and then after evacuation of the hematoma and closure of the wound, careful intubation with endotrachial tube was inserted with difficulty, but succeeded. During resuscitation also this matter played a fatal sequence.

bullet

It is the first case during 32 years of surgical activities with cervical spine surgery to have this catastrophic evens in a fragile patient with potentially multi organ and systemic failure. There are no statistic, but to my guising this mortality is the first among more than 3000 such similar operations personally operated by me.

 


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 .

  WELCOME TO AL-SHMAISANI HOSPITAL

  

[2011] [CNS CLINIC - NEUROSURGERY - JORDAN]. All rights reserved