Neurosurgery.tv Home Search neurosurgery.tv drelias@go.com.jo
Home
JANUARY
FEBRUARY
MARCH
APRIL
MAY
JUNE
JULY
AUGUST
SEPTEMBER
OCTOBER
NOVEMBER
DECEMBER
 

RELATED WEBSITES

neurosurgery.fr neurosurgery.guru
neurosurgery.me
microneuroanatomy.com
ioperativemonitoring.com
diencephalon.info
mesencephalon.org
medullaoblongata.info neurophysiology.ws
humanneurophysiology.com
e-neuroradiology.com
onconeurosurgery.com
schwannomas.com
acousticschwannoma.com
pituitaryadenoma.net
meningiomas.org
craniopharyngiomas.com
craniopharyngiomas.net
pinealomas.com
glioma.ws
ependymoma.info
spinesurgeries.org
spondylolisthesis.info
paraplegia.co
vascularneurosurgery.org
Neurosurgical Encyclopedia
cns-clinic.net
munir.ws

 
 
 
 

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.

 

 
 
 
 

12. 21-APRIL-2007  RAWAN TALEB ABU-THABET  22 YEARS  MALFUNCTIONING VENTRICULO-PERITONEAL SHUNT.

 
 

 
 

Anamnesis

bullet

The patient was operated 17-April-2007 for malfunctioning shunt and exploration of the abdominal part revealed, that it was functioning properly.

bullet

Considering, that the patient was improving, she was kept in the hospital without any medications to see her reaction later.

bullet

Suddenly at this morning, the patient got the same clinical picture of acute hypertensive-encephalic syndrome.

bullet

CT-scan was done urgently, confirming that the ventricular system still dilated.

bullet

The patient was taken to the operating room and the proximal part was explored. It was functioning with the shunt of PS medical adult 1.5 level performance.

bullet

Taking into consideration, that the cause could be due to adhesion of the ventricular part by choroid plexus, an attempt to use the most tiny endoscope failed, because the lumen was smaller.  Several rotations of the ventricular part confirmed that it is "free?". The tube was withdrawn accurately, but after 3 cm of withdrawal, the CSF became bloody, confirming, that intraventricular bleeding took place.

bullet

The ventricular part was removed completely and inspection of the tip showed that, only 2 holes were free and all the other holes were occluded by the scarous choroid plexus.

bullet

The new ventricular end was inserted and lengthy over more than one hour of washing with saline was performed at several depth levels to minimize clot formation and avoid subsequent immediate occlusion of the new shunt.

bullet

After completion of washing, the ventricular part was withdrawn and inspected. There is a clot inside the lumen at the holes area. It was decided to cut the tip of this part to prevent clot residence inside this area. After that, the shunt was constructed and checked several times at the peritoneal end for function. It was functioning properly but the CSF is still xanthochromic.

bullet

Routine closure of the wounds. Smooth postoperative recovery.

bullet

Planned to repeat CT-scan after 4-5 hours.

bullet

The patient progressed fulminant picture of meningism and peritonism  with the CT-scan showing a clot parallel to the shunt in the right posterior horn and tiny one at the occluded aqueduct of Sylvius.

bullet

The patients vital signs are acceptable, and the shunt was functioning properly, but she was transferred to the ICU and valium given to decrease the peritonism.

Comments:

bullet

The patient got sudden onset hypertensive encephalic syndrome due to unknown reasons of shunt malfunction with deteriorating visual functions, which could lead to complete bilateral blindness.

bullet

Direct check of the shunt function is mandatory, to prevent further escalation of the increase intracranial pressure.

bullet

The cause of the malfunction was suspected to be be a debris at the first operation, but when recurrence of the hypertensive-encephalic syndrome took place another time after 4 days of the first surgery, the choroid plexus became the most probable cause.

bullet

Despite the fact that great precaution was paid to prevent intraventricular hemorrhage, it took place and only lengthy washing by saline and patience were the clue for resolving the issue. Otherwise, putting external drain for 2-3 days is the next option.

bullet

There is a problem awaiting for resolution, how to dissect the adherent choroid plexus to the shunt. I suggest to make an end-welling catheter to be introduced and adapted to the ventricular part, so the after dilatation of the holes area could cause rupture of the adhesions with subsequent opening of the holes.  

bullet

For more details about pinealomas click here!

 

 
     
 

Copyright [2007] [CNS Clinic]. All rights reserved