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 .

01-MARCH-2015  JAFAR MINJID AL-HASANAT  43 YEARS PERSISTING CSF POCKET AFTER DISCECTOMY FOR L4-5 AND L5-S1.

 

Anamnesis

bullet

The patient came to the clinic 26-February-2015 complaining of huge CSF pocket under the skin 10 days after performing discectomy L4-5 and L5-S1 25-January-2015 in UAE. He has attacks of headache and fainting when changing the position. It was drained twice, the last 18-February-2015.

bullet

On examination, the patient is not limping with no scoliotic stance with SLRS 75 degrees both sides with weak dorsiflexion left foot 4/5 and hypalgesia left L5 and S1 roots. When the patient was put in supine position with coughing, the pocket raised more more than 3 cm. A compressing dressing was applied.

bullet

The patient sent for investigations: MRI lumbar spine done 26-February-2015 showing huge CSF pocket communicating with the intradural space more than 12 mm diameter at L4-5 and L5-S1 levels. Dynamic studies performed ruling out instability. Lab investigations ruled out the presence of infection.

bullet

The previous wound refreshed. A huge amount of CSF came out. Hemilaminectomy L4 and L5 and upper edge of the sacrum left side. Foraminotomy L5 and S1 left side. The left L5 root is intact, but there is recurrence of the extrusion which was removed and further cleaning of L4-5 disc space was achieved. The left S1 root was damaged and torn. There are several torn points in the posterior wall of the dura and slipped nylon stitch 4 zero. The root was compressed by an extrusion for what discectomy of L5-S1 was performed. The tears in the posterior wall of the dura were repaired by 6 zero nylon and the torn root was also repaired. Still having oozing CSF. A layer of lyodura with Glubran was applied over the posterior wall of the defective dura. There is still a tiny leak fro the lower corner of the left S1 root. BioGlue was applied to that corner and to several places to achieve water-tight repair of the dural defects. The head of the patient was maximally elevated and Valsalva maneuver was applied. No CSF leak. Routine closure of the wound.

bullet

Smooth postoperative recovery. The power of the left foot became normal.

 

 

Comments  

bullet

The patient has a huge dural defects, that will not close by time, instead they will harm the brain. Surgical repair and water-tight closure is the best solution.

bullet

The MRI data were misleading exaggerating the dural defects. They were multiple and the main source was the damaged left S1 root and tiny points near the slipped stitch at the posterior dural wall.

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 .

  

 

 

 

 

 

 

 

 

 

 

 

 

WELCOME TO AL-SHMAISANI HOSPITAL

 

 

 

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