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
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04-JULY-2013 FATMEH SALEH AL-DROOBI 19 YEARS
TUMOR OF THE RIGHT TEMPORO-OCCIPITAL LOBES WITH INTRAVENTRICULAR INVASION.
The patient came to the clinic 01-July-2013
complaining of headache for 1 month with double
vision for three weeks with LOC for 4 days 2
weeks ago with vomiting since that.
MRI brain done 23-June-2013 showed a huge mass
in the right occipito-temporal lobes involving
the inferior horn of the right lateral ventricle
pushing the mid structures to the left side. The
mass has ring enhancement with proper borders.
On examination: the patient is alert with stable
Romberg position, but the left upper limb sway
down. The oculomotor nerves functioning, but the
is disturbance of convergence with inward
strabismus when looking to near objects. There
is weak muscles left upper limb distal more than
proximal with preservation of sensation.
MRI of the brain was repeated 01-July-2013 to
confirm the previous data.
approach. Through the inferior temporal gyrus
above the trifurcation of the right Labbe sinus,
transcortical incision above the tumor. The
tumor was highly vascular with good margins. It
was coagulated and resected. Fresh frozen biopsy
gave the answer of highly malignant glioma. The
tumor borders were followed and resected. The
tumor was involving the choroid plexus of the
inferior horn and the trigone. The normal
choroid plexus was separated and bisected of the
tumor. The CSF is coming free from the inferior
horn. After major resection of the tumor bulk,
the borders of the tumor was followed all over
and practical radical removal of the tumor was
achieved. The brain regained relaxed pulsating
character. Inspection of the Labbe vein and the
subtemporal area showed good relaxation of the
anatomical structures. 2 pieces of surgicele
were applied to the tumor bed to secure more
Routine closure of the wound.
Smooth postoperative recovery.
The patient was sent to the ICU.
Postoperative control CT-scan
demonstrating the bed of removed tumor.
The histopathologist reported during surgery
that the patient has
malignant glioma. Practical gross radical resection is
the best solution at this stage.
The final histologic result was glioblastoma
multiforme with immunostaining study showing
positive results for GFAP and the proliferation
index (ki67) high (18%).
The patient was readmitted 2 days after
discharge and MRI performed 12-July-2013 showing
considerable recurrence of the tumor with
hemorrhagic event inside the tumor bed. The
patient was treated conservatively and
discharged 16-July-2013 with high dose Decadron
4 tab three times a day to undergo radiation
therapy as soon as possible.
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