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
Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses
Multigen RF lesion generator .
23-DECEMBER-2009 UMAR FATHI SUBHI ABDALLAH
35 YEARS RESIDUAL AFTER GUN SHOOT 2002 OF THE RIGHT KNEE WITH
SUSPECTED PAINFUL NEUROMA AND NON-FUNCTIONING RIGHT TIBIAL NERVE.
Please! wait for 3-5 min till the
video start to load. It depends upon the internet
came to the clinic 16-June-2003 complaining of
condition after gun shoot to the right knee
01-June-2002 with non-functioning tibial
nerve of the right leg. The patient was operated
The patient then came to the
clinic 30-July-2007 still complaining of non
functioning right tibial nerve and pain behind
the right knee, which was suspected as painful
The patient the n came
11-July-2009 and 19-December-2009 with ECS
performed 17-December-2009 confirming that the
right tibial nerve is not functioning and very
mild involvement of the right peroneal nerve.
The patient to this moment underwent 5 surgeries
to the lesion.
The lower third of the
sciatic nerve was exposed and it was involved in
massive scar in its lower part. Using ISIS
HIghLine IOM the peroneal side of the sciatic
nerve was functioning well and was responding
well to currents with 1mA stimulation, but the
tibial side was not functioning at all.
Neurolysis was undertaken and
the tibial and peroneal nerves were neuroyzed
down 7-8 cm below their emergence. The division
was of low variant and the tibial nerve start to
respond gradually to 4mA the 2 mA and the 1 mA.
This was recorded and documented in the ISIS IOM
and video-recorded. It was possible to record
brisk response of planterflexion group of
muscles during tibial nerve stimulation.
Routine closure of the wound.
The movement of the right foot improved slightly
and some planterflexion appeared after recovery.
The suspected painful neuroma
could be a swelling of the nerve above some scar
constriction, which disappear usually after
Without using IOM, it is
impossible to make the proper decision of the
best treatment modality fit to the patient.
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 .