Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity.

Functional Neurosurgery
functionalneuro.surgery
Functionalneurosurgery.net

IOM Sites
iomonitoring.org
operativemonitoring.com

Neurosurgical Sites
neurosurgery.art
neurosurgery.me
neurosurgery.mx
skullbase.surgery

Neurosurgical Encyclopedia
neurosurgicalencyclopedia.org

Neurooncological Sites
acousticschwannoma.com
craniopharyngiomas.com
ependymomas.com
gliomas.info
meningiomas.org
neurooncology.me
onconeurosurgery.com
pinealomas.com
pituitaryadenomas.com 

Neuroanatomical Sites
humanneuroanatomy.com 
microneuroanatomy.com

Neuroanesthesia Sites
neuro-anesthessia.org

Neuroendocrinologiacl Site
humanneuroendocrinology.com

Neurobiological Sites
humanneurobiology.com

Neurohistopathological
neurorhistopathology.com

Neuro ICU Site
neuroicu.info

Neuroophthalmological
neuroophthalmology.org

Neurophysiological Sites
humanneurophysiology.com

Neuroradiological Sites
neuroradiology.today

NeuroSience Sites
neuro.science

Neurovascular Sites
vascularneurosurgery.com

Personal Sites
cns.clinic

Spine Surgery Sites
spine.surgery
spondylolisthesis.info
paraplegia.today

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 .

26-MARCH-2017  KHALED IBRAHEEM SALAMEH  47 YEARS   HUGE EXTRUDED DISC C5-6 CENTRAL WITH RIGHT FORAMINAL OCCLUSION.

 

Anamnesis

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The patient came to the clinic 22-March-2017 complaining of neck, right upper limb pain and numbness right hand for 45 days and numbness right foot the last 2 days with cephalgia. MRI cervical spine performed 11-March-2017 showing huge extruded disc C5-6 central with right foraminal occlusion.  The patient in Concor 2.5 mg once daily for 5 years.

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On examination, the patient is in agonizing pain. He has pain when turning the head to the left, up, down, and when bending the head to both shoulders, more to the left. There is weak flexion, extension right hand -4/5 and right triceps 3/5. There is also weak dorsiflexion right foot 4/5.

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he patient was sent for cardiac evaluation.

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Through anterior approach, discectomy C5-6 was performed with removal of the extrusion until the dura was seen all over the posterior edges of C5 and C6.  Using MultiGen, bipolar motor stimulation of the right C6 root  was achieved within the disc space with 2.2 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to right C6 root was achieved using 2 bended catheters 10 mm exposed length. Further bipolar motor stimulation of the right C6 was achieved with 2.0 V with more vivid response. Solis cage 6x12 mm with Vitos bone graft (TCP) were inserted to disc space. One level Reflex Hybrid Stryker ACP 16 mm length was used with 4 screws 16x4 mm were used to fuse C5-6. Routine closure of the wound. All stages of surgery were C-arm guided.

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Smooth postoperative recovery. The power of the right upper limb normalized. He was sent to the ward.


MultiGen

 

Comments  

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The recurrence rate in cervical disc surgery is zero.

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This is the 113th case using the BPRF mode with MultiGen. This procedure regained routine acceptance.  It became a usual part of the spine and peripheral nerves surgery. Click here for reference.

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It still unclear to evaluate the differences of pre and post application motor responses. The only sure thing that it tells that the electrodes did not migrate during the procedure and the nerve is functioning properly. Here there was slight improvement of the threshold of stimulation power of motor stimulation of the right C6 root.

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With accumulation of data, it became clear that the irritated nerve with aberrant currents running in the C fibers up, not only causing no change or elevation of the required voltage to achieve motor response, but they could cause the preoperative weakness. Ablation of such currents results in facilitation of the motor response and improvement of function with disappearance of pain.

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It is unclear why the roots have several motor response with different patients, despite the fact that the neurological status is the same and the anesthesia protocol also the same.

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It could be that the nerve is recovering minute by minute after decompression and this can explain why the motor conductivity is improving after the BPRF application, which require 4-5 minutes session.

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


Inomed Riechert-Mundinger System, with three point fixation is the most accurate system in the market. The microdrive and its sensor gives feed back about the localization.


Inomed MER system

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

 


Intraoperative MRI Suite with whole neurological monitoring.


Relationship of the vertebral arteries, disc space and spinal roots

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

 


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