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
Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses
Multigen RF lesion generator .
The trilateral approach has several advantages
to visually control all aspects of the tumor
with different angles, making practical
resection of such huge tumor feasible.
Such surgery must have difficult postoperative
course, which must be considered with great
For more information about the trilateral
The patient came to the clinic
17-April-2002 from Egypt complaining of bilateral sciatica, more the
right. She had fracture med third right tibia with subsequent plate
fixation 12 years ago. Exacerbation of LBP the last 3 years with
ataxic gait for 2 months. She had diabetes mellitus for 1 year in diamicron
and glucophage. Arterial hypertension for 6 years in hypoten 50 mg
once daily. She had also hypercholesterolemia.
On examination, she had unstable Romberg swaying
to all directions. Mild bilateral lagophthalm was noted. SLRS was 90
degrees both sides with Babinski positive left side. Hypalgesia with
numbness both feet with weak muscles both feet more the left.
Considering these data, the patient was sent to
perform MRI of the brain with MRA of the brain and carotids
with MRI of the lumbar spine.
The patient showed
postoperative medullary signs with left sided
hemiparesis which persisted for several days,
with complete resolution of the signs over 10-14
The patient came back to the clinic
23-April-2002 with MRI of the brain, showing giant tentorial edge
meningioma with mild spondylolisthesis L5-S1. The patient was advised to undergo surgery for
the meningioma, and she was surprised, that she was claiming of LBP
and why, she must be operated for her brain tumor. It was explained
for her, that most of her complains were due to the tumor.
In setting position, a long
vertical incision of the skin was created over
the posterior mid parietal and occipital region.
The wide bone flap was created and reflected
down to the lower corner of the wound, so that
to confluence sinuum was at the center of the
bone defect. A V-shaped incision of the dura was
created over the cerebellar hemispheres
and reflected up. Subtentorial approach to the
tumor was proceeded and the meningioma was seen
and piece-meal resection of the visible tumor
was achieved. Dural incision over the right
occipital lobe parallel to the superior edge of
the transverse sinus and posterior third of the
SSS and the seen parts of the supratentorial
part of the tumor was resected. Then
infratentorial approach was used to continue the
tumor removal. All efforts were taken to
preserve the deep cerebral vein and its
divisions. The left occipital approach in this
case was not needed. Hemostasis and routine
closure of the wound.
recovery. The patient was sent to the ICU for
observation. She progressed dense left sided
plegia and deep paresis of the right with
aphonia and swallowing difficulty and was
semicomatose, but started to recover over one
week in the ICU. In the ward she continued to
recover and she could walk the 10th
postoperative day with help and all neurological
deficits regressed dramatically.
The patient came to the clinic 25-May-2002 with
ataxic gait. She was in glucophage twice daily, Amaryl 2 mg once
daily and hypoten 50 mg once daily. She received trental, tapering
doses of Epanutin, Gincosan and L-thyroxin 100 microgram once daily.
She was sent for follow-up MRI and lab investigations and came
30-June-2002. MRI done 30-June-2002 showing residual of the mass 2x2
mm at the sinus recti junction. Thyroid functions were within normal
limits. She was advised to decrease the L-thyroxin and to be
followed by endocrinologist and come back after one year.
The patient came back 27-December-2003 with the recurrence 3x3 mm.
Romberg was stable the walking improved considerably. She had
hypalgesia of the index left hand, weak dorsiflexion big toe right
foot with hypalgesia of right L5 territory. She improved
dramatically and no lagophthalm and she was advised in case of
considerable enlargement of the tumor, to undergo radiotherapy.