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NEWS

January/06/2007

Surgical treatment in paraplegia survey:

Cross-anastamosis in paraplegia below D9 started to give results. The last documented case operated 1 year ago in a patient from Israel came to the clinic 3 weeks ago. ECS and EMG performed showed that there is starting innervation of Th 11 and 12. The patient's lower limbs muscles became bulky and he could contract the lower abdominal muscles and some movements in the pelvic girdle. Crude sensation descended down to the inguinal level both sides. If you are more interested in this topic, click here! 

March/08/2007

Tuberculosis of the spine

In the last 2 years the incidence of tuberculosis of the spinal column is becoming more frequent and having different clinico-morphologic picture. This phenomenon is alarming sign as the residual of the use of dirty bombs and several radioactive materials in the surrounding dirty wars in the region. For demonstration click here! and here!

20-AUGUST-2007

SIEMENS Digital C-arm is implemented and functioning in the Shmaisani hospital.

30-AUGUST-2007

The Inomed ISIS Highline neurophysiologic navigation system start to work at the operating room.

28-November-2013

Magnetom Skyra 3 tesla with all clinical applications start to run.

 

 
 
 
 

2.  15-JANUARY-2007 AYESHA KHALEEL BADAWI  54 YEARS  RECALCITRANT LEFT TRIGEMINAL NEURALGIA AFTER FAILED GAMMA-KNIFE TREATMENT.

 

 

Anamnesis

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The patient came 03-September-2003  complaining of left trigeminal neuralgia for 3 years. She was under treatment with neurontine 300 mg  5 times a day with Rivotril  0.5 mg 4 times a day. MRI performed at that time ruled out the presence of other pathologic processes.

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The patient, then came 06-January-2007 with agonizing pain, claiming that, she underwent Gamma-knife treatment for neuralgia 24-October-2003 without any benefit.

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The patient in mega-doses of neurotop, neurontine, Rivotril, xanax  and lexotanil. Despite that, she was in agonizing pain. The patient came urging for surgery.

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In setting position, left retromastoid approach was performed and the sigmoid sinus was torn during that, and it was repaired by nylon 6 zero.

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The vein of Dendy was coagulated and the arachnoid around the left trigeminal nerve was dissected. The arachnoid in the lateral part was thick, which could be due to Gamma-knife effect. The major branch of left AICA was dissected away from under the trunk of the trigeminal nerve. Inspection of the veins was unremarkable. Inspection of one of the branches of the AICA revealed that, it was buried in the brainstem under the axilla of the trigeminal nerve. This part was dissected and the loop was elevated from the inside tissues of the proximal part of the nerve and the loop tip was calcified and turning back to emerge anterior to the trigeminal nerve and then take it's normal course in the brain stem. This loop jumped away anterior to the emergence of the trigeminal nerve.

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Using muscle coated around the nerve and surgicele between the muscle and the loop and Teflon, separation of the nerve was secured off the loop.

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Smooth postoperative recovery and immediate postoperative disappearance of the trigeminal neuralgia. No complications could be noticed.

Comments:

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The golden standard in treatment of neuralgia in young aged patients remain microvascular decompression of the affected trigeminal nerve.

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Gamma-knife have suspicious role in trigeminal neuralgia treatment.

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Ballooning and radiofrequency thermodistruction have high recurrence rate.

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For further theoretical background, please click here!

 

 
     
 

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