Munir Elias 20-12-2013

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  neurosurgery.tv

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Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses


Multigen RF lesion generator .

14-SEPTEMBER-2014  ABDALLA WAFIQ FAHMAWI  28 YEARS PERSISTENT CSF LEAK FROM THE LEFT MIDDLE FOSSA AFTER TRAUMA 10 YEARS AGO.

 

Anamnesis

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The patient came to the clinic 19-July-2014 complaining of CSF leak after trauma 10 years ago with recurrent episodes of meningitis for 5 years. Remission took place, but the last 2 months got CSF leak from the left nostril. CT-scan done 19-June-2014 bad quality, not informative.

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On examination; the patient is neurologically free, except the episodes of the CSF leak with headache and decreased hearing left ear. The patient was sent for thorough investigations: MRI 22-July-2014 showing CSF pocket in the eroding left middle fossa. CT-scan with with reconstruction using ORS Visual showing the bony destruction reaching the cochlea of the left pyramid.

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Osteoplastic craniotomy immediately above the left ear with reflection of the flap anterior. Extradural approach to the subtemporal area. The old fracture of the anterior part of the petrous bone exposed. It was necessary to perform also intradural approach to inspect the structures intradurally. There was a huge bony defect in the posterior part of the left cavernous sinus. The left oculomotor nerve was seen running under the defect. There was a huge fossa anterior to the foramen ovale, through which the left V1 was running. The dural defect was filled with muscle harvested from the temporal muscle and glue used to keep the muscle in place. This was done to avoid mechanical trauma to the running left oculomotor nerve running under. Using bone granules 5 ml the cavity anterior to the foramen ovale and the bone defect in the petrous bone were filled snuggly extradurally to prevent any other unseen defects. Glue was applied over the bone granules. The dura was closed water-tightly and routine closure of the wound.

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Smooth postoperative recovery. The patient was sent to the ICU for 12 hours observation.

 

 

Comments  

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The patient has CSF leak from the old bony fracture of the left middle ear reaching the Eustachian tube and eroding the entire left middle fossa. All the suspected sources of the CSF leak must be dealt accordingly.

Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.

Leica HM500

Leica HM500
The World's first and the only Headmounted Microscope.
Freedom combined with Outstanding Vision, but very bad video recording and documentation.

TRUMPF TruSystem 7500

After long years TRUMPF TruSystem 7500 is running with in the neurosuite at Shmaisani hospital starting from 23-March-2014


Inomed MER system


The bone defect in the tip of the pyramidal bone just anterior to the left cochlea.


The bone defect covered by a piece of muscle with glue and bone granules with glue to fill most of the gaps. The CT-scan done the next day after surgery to confirm the taken actions are proper.

Back Up!

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 .

  

 

 

 

 

 

 

 

 

 

 

 

 

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