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 .

06-JANUARY-2017  ALI MAHER MUBARAK  64 YEARS  OSTEOMYELITIS D8-9-10 WITH PENDING COMPLETE PARAPLEGIA.

 

Anamnesis

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The patient was operated by me 1997 for PLD L5-S1 and was doing well. The patient then progressed heart failure 2002 and was treated conservatively. I march-2015 heart pacemaker was inserted in India, after what the patient progressed heamaturia was was treated for long time for UTI. The patient then progressed back pain and CT-scan performed 20-November-2016 mild bulge L3-4. The patient then came 09-December-2016 to the clinic walking with complains of back pain. 

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On examination, the patient was neurologically free except for midback pain. Considering that it was dangerous to perform MRI of the whole spine, it was decided to perform whole body CT-PET with other investigations. PET-CT-scan was performed 11-December-2016 and showed hyperactive lesion extending from D8, 9 to D10. The patient was sent to oncologic consultation and investigations confirmed the presence of Klebsiella pneumonia sensitive to Gentamicin and Amikacin. He was treated by infectious specialist by Tygacil  50 mg I/V  twice daily.

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The patient then came 05-January-2017 telling that he showed dramatic deterioration , in wheelchair with plegia right lower limb and severe weakness left lower limb with analgesia 5 cm above the umbilicus and below both sides.

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The patient was sent for new investigations and Chest CT-scan was without proper information, but continuous thin cuts 0.75 mm from D4 down to the mid of D11 with contrast, using ORSVisual application, it was possible to see the supposed to be an epidural pus fulfilling the right side from D8-9-10 with paravertebral abscess reaching the aorta and retropleural cavity both lungs.

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Skeletonization of the right side of D8-9-10. Right hemiflavotomy D9-10 and D8-8. No pus is coming out, but severe compression was noted. Complete decompressive laminectomy D9, upper half of D10 and lower half of D8 until the normal epidural fat was noted. There is remnants of epidural fat with inflammatory process. The decompression was performed, so that to preserve stability of the dorsal spine and provide sufficient decompression to the spinal cord. Routine closure of the wound with Ready Vac .

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Smooth postoperative recovery. The power of the left leg improved dramatically, but the right lower limb still the same. He was sent to the ward.

 

Comments  

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The patient having viscous cycle of infection hitting several organs started after heart pacemaker implantation.

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CT-scan in not reliable technique for soft tissue detection in the spinal column. It can give disinformation up to 70% as in this case.

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Surgical decompression was necessary in this case and the uncertainty of the CT-scan date were considered to put plan A and B.

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Adamkiewicz arteries supply the spinal cord from the left side. Here the clinical picture is opposite. Despite that Nootropil and Clexane were started after surgery to rule out vascular compromise.

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

 


3D-CT-scan reconstruction showing the epidural abscess behind D8,9,10.

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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