Inomed Stockert Neuro N50. A versatile
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Multigen RF lesion generator .
10-MAY-2026 AMIRA MAHER AL-SHAREEF 28
YEARS CONDITION AFTER VPS INSERTED 28 YEARS AGO WITH
CONVULSIONS THE LAST YEAR.
Anamnesis
The patient came to the clinic 02-May-2026 with
father telling that the last year complaining of
drowsiness and attacks of falling down with
proper convulsions the last 8 months with
headache and right sided cephalgia and
neck pain. The patient felt down in the back to
right posterior aspect of the neck 3 years ago.
2 years ago suffered Jacksonian seizure of
the right upper limb with blurred vision. Since
that time she was in Tegretol CR 200 mg 2
tab twice a day and keppra 500 twice daily. VPS
was inserted at first week of life and revision
was done 1 month later. She underwent several
orthopedic surgeries for spastic paraparesis of
both lower limbs.
On examination, the patient is limping with
scoliotic stances. The dorsi and planterflexion
right foot is 0/5, but the left foot is 3/5.
The patient was sent for investigation and MRI
brain showing the right ventricular system is
acceptable with cystic degeneration of the left
occipital lobe down to the tuber cinereum
of the III ventricle . X-rays showing rupture of
the VPS tube at the level of C1-2. MRI whole
spine ruled out tonsilar herniation or tethered
cord. CT-scan of the skull showing the tip of
the shunt at the bur hole area and no reservoir.
EEG confirming epi activity both temporal lobes.
Supine position.
Inspection of right VPS. It was occluded and not
functioning. It was removed. Craniotomy left
occipital area and fenestration of the arachnoid
cyst, after what the brain collapsed and the
falx cerebri was seen at the medial pat of the
cavity. Multiple fenestrations were achieved to
obtain CSF circulation. It was noted that the
patient had polyuria fir what the urine was sent
to specific gravity, which was normal denying
diabetes insipidus, Smooth postoperative
recovery. She was sent to the ward.
FOLLOW UP
Too early now.
Comments
The case is very complicated, because
there are no previous MRI data to compare with.
The VPS has small reservoir, and not
functioning for unknown period.
The family have controversial
information, that the surgeon cannot configure what is going
on, but the Jacksonian attack of the right upper limb, which
took place 2 years ago and the the drop right foot, can
denote that the seizure activity took place from the leg and
hand area of the sensomotor strip left hemisphere.
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
The World's first and the only Head mounted Microscope.
Freedom combined with Outstanding Vision, but very bad video recording and
documentation.
After long years TRUMPF TruSystem 7500 is running with in the neurosuite at
Shmaisani hospital starting from 23-March-2014
LooksCam II Xenosys in the run starting from 14-March-2021 with
SheerVision TTL x4 magnification.
Cios-Spin flat panel in the run.
CT-scan with ORS Visual reconstruction showing the tip of the shunt
abutting the brain. Notice that there is no reservoir and it is
disconnected at the level of C1-2.
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 .
