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 .

27-NOVEMBER-2017  LUBOV IVANOVNA BELICHENKO  64 YEARS  CA BREAST WITH COMPLETE INVOLVEMENT OF THE RIGHT BRACHIAL PLEXUS.

 
 

Anamnesis

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The patient is my wife, started to complain of hips pain for 14 months and the edema of the right upper limb for several days, one year ago. Radiological studies and fine needle aspiration confirmed the presence of Ca breast right side with involvement of the pleural ipsilateral to tumor with lymph node involvement and scattered metastasis in the cervical, dorsal, lumbar and pelvis with tendency to grow inside the bones. The right shoulder bones were also involved in the process. The tumor was progesterone positive and she underwent 6 sessions of combined chemotherapy followed with femara. The last month, the femara was ineffective and caused all the side effects. The tumor regional metastasis at the right brachial plexus showed drop wrist for 4 months, then the other branches of the the brachial plexus took place with the right upper limb became useless, but with agonizing pain.  

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2 weeks ago, the plan for lumpectomy and exploration of the brachial plexus was anticipated, and preoperative investigations showed Hb 7 mg/L with ESR and CRP and high enzymes of the liver. She was given 4 units blood and 4 units FFP. MRI of the cervical spine was showing intraossal involvement of the metastasis with the bony structures acceptable. MRI of the right brachial plexus showed escalation of the lymph nodes metastasis involving the supra and subclavicular region. MR mammography ruled out the presence of the lump. During this an intrapleural effusion of the right chest was noted, for what chest CT-scan was performed and CT-scan of the cervical spine was performed. The fluid was evacuated the next day and sent for investigations. CXS showed no bacterial growth. Cardiologist was consulted and he noticed mild pericardial effusion. Consultation of the oncologist gave green line for surgery to explore the right brachial plexus. Since the lump in the breast is not seen, then lumpectomy discarded from the plan.

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Incision behind the right SCMM and running 2 cm above the right clavicle. The platysma was bisected and the hard highly vascular mass was identified. The right IJV was followed inferior and the omohyiod muscle was seen and left intact. The phrenic nerve was followed and the the cleavage between the right anterior scalene and medial scalene was identified. The tumor was totally removed. It was stony hard and pushing the trunks inferior. It was sent for histopathologic studies. Inspection of the supra and retroclavicular regions revealed no remnants of the tumor. The transverse cervical artery was coagulated and cut during surgery, because it was feeding the tumor. During dissection most of the time Inomed TC bipolar forceps with N50 was used with continuous stimulation to avoid neural injury. Using MultiGen, bipolar motor stimulation of the upper trunk gave brisk response to 4.4 V, the middle trunk for 3.25 V and the lower trunk with 1.8V. MultiGen with 2 Hz with 240 ms duration and 42 degrees was applied to all three trunks. Routine closure of the wound. Before extubation the pleural fluid in the the right chest was evacuated and around 35 ml was achieved. It was sent to histological studies.

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Smooth postoperative recovery.  The patient got some movement of the right upper limb more pronounced in the distal muscles. She was sent to the ward.


MultiGen

Comments  

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The patient is my wife, and she is urging for surgery, to alleviate the agonizing pain of her non-functioning right brachial plexus. All my long-standing experience I must give her, even if the results are under question.

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This is the 139th 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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The plan for infraclavicular exploration was omitted because the trunks  was responding in acceptable fashion.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 Head mounted 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

 


 

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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