Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity.

Functional Neurosurgery
functionalneuro.surgery
Functionalneurosurgery.net

IOM Sites
iomonitoring.org
operativemonitoring.com

Neurosurgical Sites
neurosurgery.art
neurosurgery.me
neurosurgery.mx
skullbase.surgery

Neurosurgical Encyclopedia
neurosurgicalencyclopedia.org

Neurooncological Sites
acousticschwannoma.com
craniopharyngiomas.com
ependymomas.com
gliomas.info
meningiomas.org
neurooncology.me
onconeurosurgery.com
pinealomas.com
pituitaryadenomas.com 

Neuroanatomical Sites
humanneuroanatomy.com 
microneuroanatomy.com

Neuroanesthesia Sites
neuro-anesthessia.org

Neuroendocrinologiacl Site
humanneuroendocrinology.com

Neurobiological Sites
humanneurobiology.com

Neurohistopathological
neurorhistopathology.com

Neuro ICU Site
neuroicu.info

Neuroophthalmological
neuroophthalmology.org

Neurophysiological Sites
humanneurophysiology.com

Neuroradiological Sites
neuroradiology.today

NeuroSience Sites
neuro.science

Neurovascular Sites
vascularneurosurgery.com

Personal Sites
cns.clinic

Spine Surgery Sites
spine.surgery
spondylolisthesis.info
paraplegia.today

Stem Cell Therapy Site
neurostemcell.com


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


Multigen RF lesion generator .

22-JANUARY-2017  AHMAD FAYEQ ABU-SAMHAN  35 YEARS  HUGE RECURRENT DISC L4-5 WITH RIGHT UPWARD MIGRATION.

 

Anamnesis

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The patient came to the clinic 17-January-2017 complaining of LBP and right sciatica for 20 days with numbness all toes right foot. He was operated elsewhere for PLD L4-5 for right sciatica 20 years ago. MRI lumbar spine performed 02-January-2017 showing recurrent disc L4-5 with right upward migration.

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On examination, the patient is not limping with mild scoliotic stance. SLRS was 50 degrees in the right and 65 degrees in left side with pain both sides. There is weak right foot dorsiflexion -4/5, planterflexion same foot -5/5. The patient has very long incision extending to the coccygeal region.

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The patient was sent for new investigations and dynamic studies were uneventful.

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Right L4 neurolysis and foraminotomy was achieved. The Level of the L4-5 was identified with scarolysis of the right L5 root. The extruded disk was removed lateral to the axilla under the L4 root. Right sided cleaning of L4-5 was performed. Using MultiGen, bipolar motor stimulation of the right L4 was achieved with 1.8 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to the right L4 root was achieved using 2 bended catheters 10 mm exposed length. Further motor stimulation done to the same root and the response was 0.6 V in the right L4 with more brisk response. The right L5 root was not scarolysed since it was below the operative activity. Routine closure of the wound.

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Smooth postoperative recovery. The power of the right foot improved and he was sciatica free. He was sent to the ward.


MultiGen

 

 

Comments  

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The patient still having an estimated postoperative re-recurrence less than 7%, because the disc space is shallower than before.

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This is the 101st case using the BPRF mode with MultiGen. This procedure regained routine acceptance.  It became a usual part of the spine and peripheral nerves surgery. Click here for reference.

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It still unclear to evaluate the differences of pre and post application motor responses. The only sure thing that it tell that the electrodes did not migrate during the procedure and the nerve is functioning properly. Here there was considerable improvement of the threshold of stimulation power of motor stimulation after the BPRF.

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With accumulation of data, it became clear that the irritated nerve with aberrant currents running in the C fibers up, not only causing no change or elevation of the required voltage to achieve motor response, but they could cause the preoperative weakness. Ablation of such currents results in facilitation of the motor response and improvement of function with disappearance of pain.

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It is unclear why the roots have several motor response with different patients, despite the fact that the neurological status is the same and the anaesthesia protocol also the same. In this case adhesions could be a factor for initial high voltage requirement to achieve motor response, but adhesions were relatively minimal around the root, for what considerable improvement was achieved.

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


Inomed Riechert-Mundinger System, with three point fixation is the most accurate system in the market. The microdrive and its sensor gives feed back about the localization.


Inomed MER system

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

 


Axial and Saggital view showing the recurrence at L4-5 with upward migration.


In this case the VITOM was inferior and binocular loops head mounted was used because the VITOM is static in position and visual aid is not stereoscopic as the loops, taking into consideration the wound is full of scars and rapid action is required to perform the meticulous dissection.

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 .

  

 

 

 

 

 

 

 

 

 

 

 

 

WELCOME TO AL-SHMAISANI HOSPITAL

 


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