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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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.
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.
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
Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.
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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 .