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.fr

Functional Neurosurgery
functionalneuro.surgery
Functionalneurosurgery.net

IOM Sites
iomonitoring.org
operativemonitoring.com

Neurosurgical Sites
cns-online.com
cns.surgery
cns.today
e-neurosurgery.com
neurosurgery.ag
neurosurgery.bz
neurosurgery.co
neurosurgery.cz
neurosurgery.fr
neurosurgery.gallery
neurosurgeryvideo.gallery
neurosurgicalvideo.gallery
neurosurgery.guru
neurosurgery.me
neurosurgery.mx
neurosurgery.photos
neurosurgery.tips
neurosurgery.tv
neurosurgery.tw
neurosurgeryspine.org

Neurosurgical Encyclopedia
neurosurgicalencyclopedia.com
neurosurgicalencyclopedia.net
neurosurgicalencyclopedia.org

Neurooncological Sites
acousticschwannoma.com
craniopharyngiomas.com
craniopharyngiomas.net
ependymomas.com
ependymomas.net
glioma.co
gliomas.info
glioma.ws
meningiomas.info
meningiomas.org
neurooncology.me
neurooncology.tv
neurooncology.ws
onconeurosurgery.com
pinealomas.com
pituitaryadenomas.com
pituitaryadenoma.net
schwannomas.com
theneuro-oncology.com

Neuroanatomical Sites
diencephalon.info
diencephalon.org
humanneuroanatomy.com
medullaoblongata.info
mesencephalon.org
microneuroanatomy.com

Neuroanesthesia Sites
neuroanesthesia.info

Neuroendocrinologiacl Site
humanneuroendocrinology.com

Neurobiological Sites
humanneurobiology.com

Neurohistopathological
neurorhistopathology.com

Neuro ICU Site
neuroicu.info

Neuroophthalmological
neuroophthalmology.org

Neurophysiological Sites
humanneurophysiology.com
neurophysiology.ws

Neuroradiological Sites
neuroradiology.ws

NeuroSience Sites
neuro.science

Neurovascular Sites
vascularneurosurgery.com
vascularneurosurgery.net

Personal Sites
cns.clinic
cns-clinic.net
cnsclinic.org
munirelias.com

Spine Surgery Sites
spine.surgery
spinesurgeries.org
spinesurgery.ws
spondylolisthesis.info
paraplegia.ws

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 .

14-APRIL-2015  AMIRA HASAN AL-ZOOBI  69 YEARS  SEVERE CERVICAL STENOSIS C3-4 WITH SPONDYLOLISTHESIS AND MALACIA OF THE SPINAL CORD.

 

Anamnesis

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The patient was operated by me 09-May-2001  for huge extrusion L3-4 with left downward migration. The patient then was operated by me 18-August-2003 for huge extruded disc C4-5 severely compressing the spinal cord. The patient is a known diabetic with rheumatoid manifestations and has gout under treatment. The patient then came 06-November-2013 with left knee pain and partial tear of the ACL was established. The patient then came 14-February-2015 telling that she was admitted to Islamic hospital in Amman with weak left upper and lower limbs for 2 weeks. MRI cervical done 01-February-2015 showing severe cervical stenosis C3-4 and C4-5 with spondylolisthesis L1-2  with old infarction of the left fronto-parietal lobes. CXR showing cardiomegaly.

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On examination: the patient is in wheelchair for 2 weeks with weak all muscles left upper and left lower limb 2-3/5with preserved sensation and pathologic reflexes in the left side. Exacerbation of deep reflexes left side. Micturition was normal. Considering the bad quality of the MRI and lack of information about the dynamic status of the neck, another MRI investigation and dynamic studies were performed the day before surgery. MRI data support the severe stenosis at C3-4 with hint spondylolisthesis. Dynamic studies confirmed the presence of considerable spondylolisthesis more in flexion position.

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Using the C-arm, the level of C3-4 was identified and discectomy of C3-4 was achieved until the dura was seen all over. To achieve overdistraction of the posterior elements an anatomical cage 6 mm height was inserted. Using Atlantis cervical plate 25 mm length one level and 4 screws 4x15 mm, fusion and reduction of C3-4 was achieved. The wound was closed and the patient was sent for intraoperative MRI. The stenosis was resolved and the CSF was seen anterior and posterior to the spinal cord. After that, the patient was extubated.

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Smooth postoperative recovery. The power of left upper limb improved considerably.

Follow Up

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The patient the second postoperative day showed considerable deterioration of the left lower limb power distal parts and to lesser degree of the left upper limb. Decadron was started and the patient showed considerable improvement at the end of the day.

 

Comments  

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With bad information, the surgeon could go to wrong surgical decision. It is a rule to check several times and perform proper clear investigation to achieve the best results with minimal intervention.

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It was planned before surgery, that if the stenosis persist, then to perform posterior decompression. Intraoperative MRI ruled out the necessity for the later procedure.

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


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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[2015] [CNS CLINIC - NEUROSURGERY - JORDAN]. All rights reserved