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Multigen RF lesion generator .

29-DECEMBER-2010  AMIRA FAHED AL-HAYEK 65 YEARS  D4 INTRADURAL MENINGIOMA WITH LEFT BROWN-SEQUARD SYNDROME.

Anamnesis

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The patient came to the clinic 20-December-2010 complaining of LBP for 8 years with bilateral sciatica for 3 years with exacerbation the last month more to the right, down to right L5 territory. MRI lumbar spine performed 14-December-2010 showing bulge L2-3, L4-5 and L5-S1. The patient has osteoporosis. She is a known diabetic and with arterial hypertension.

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On examination: The patient  is walking with help, limping with exaggerated scoliotic stance. The patient has analgesia 20 cm above the umbilicus right side. She has weak dorsiflexion both feet more weak in the left 3/5.  The right quadriceps femoris is 4/5. SLRS was 70 degrees in the right with pain. She has effusion both knees.

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The patient was sent for investigation, which showed a mass intradural compressing the spinal cord at D4 level. MRI both knees showed effusion of the knees with severe degenerative changes and tear menisci. CRP was 10.9 mg/L. RF  26.3U/ml, ESR =75 mm/h, Uric acid 7.9.

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Laminectomy of D4 was performed with partial of D3 and D5 with the guidance of image-intensifier. IOM ISIS HighLine was used with dorsal tumor protocol. The epidural fat was absent at the tumor localization. The dura was opened over the tumor and the incision was extended to see to upper and lower pole of the tumor. The tumor was with poor vascularity and it was separated from the compressed spinal cord by arachnoid membrane. The matrix was at the incision location. The tumor was totally removed and the dura was coagulated at the matrix site and the arachnoid with tumor dirt was removed to lessen future recurrence.

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Routine closure of the wound. Smooth postoperative recovery with normalization of the power of both lower limbs.


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Comments

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Brown-Sequard syndrome is the manifestation of the involvement of the half of the spinal cord in axial section, but in the life and practice, it comes with atypical picture with different manifestations, depending upon the character of mass effect.

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Usually meningiomas are with high vascularity in other locations, but in the spinal cord it seems that they are poor in vascularity.

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