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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.

 

 
 
 
 

16.  30-APRIL-2007  AMAL ADNAN AL-AZAB  36 YEARS  RESIDUAL AFTER EXCISION OF GIANT CLIVAL MENINGIOMA LEFT CLIVO-TEMPORAL WITH LEFT FACIAL PARALYSIS

 
 

 
 

Anamnesis

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The patient came to the clinic 21-April-2007 complaining of complete paralysis of the left facial nerve with deafness.

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The patient was operated by me 15-January-2006 for giant clival meningioma with involvement of the left tentorium and massive hyperostosis of the left temporal bone.

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MRI and CT-scan performed 17-September-2007 showing no recurrence.

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Considering that the facial paralysis is complete within 17 months after the first surgery, the patient sent to ECS and EMG, which confirmed complete non-function of the left facial nerve.

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The left hypoglossal nerve was exposed and the left facial nerve was drilled off the canal  for 10 mm depth and the hypoglossal nerve was sharply cut  just before the emergence of the ansa cervicalis.  It was rotated upward and direct anastamosis was performed between the 2 nerves.

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Smooth postoperative recovery.

Comments:

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So as to avoid cosmetic deformity, the tip of the mastoid was kept intact, using osteotomes, which was returned back at the end of the operation and fixed to the muscle attachments above and below, avoiding by that the formation of postauricular cavity.

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Considering the absence of recurrence of the tumor and more than 1 year of waiting for the nerve to recover, without results bridge anastamosis  was suggested.

   
 

Fig.-1: The anatomical relationship of the facial and hypoglossal nerves.

 
 
Fig-2: The anastamosis performed.   Fig-3: The tip of mastoid returned.
 
     
 

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