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.tv
Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses
Multigen RF lesion generator .
06-FEBRUARY-2003 MAEN YAHIYA SULAYMAN AL-QARALAH 26 YEARS GUN
SHOT RIGHT BRACHIAL PLEXUS WITH COMPLETE DENERVATION OF THE ULNAR NERVE AND
SEVERE PARTIAL DENERVATION OF ALL OTHER MAJOR BRANCHES.
Anamnesis
The patient came to the clinic 19-December-2002
telling that he suffered gun shot 2 months ago,
after what he got severe right brachial plexus
injury.
On examination: the patient has full power of
the right deltoid and pectoralis muscles. The
right biceps is not functioning and there is
analgesia of the volar side of the forearm. The
right radial and ulnar nerves are not
functioning. The median nerve is severely
affected but incomplete
The patient was sent for MRI cervical spine with
myelography to rule out avulsion of the roots.
Several ECS of the right brachial plexus was
performed.
Exposure of the distal part
of the right brachial plexus and the median and
musculocutaneous nerves were identified. They
are functioning with stimulation. The axillary
and the radial nerves also functioning. The
ulnar nerve involved with more massive scar was
dissected distal and proximal to the lesion.
There is neuroma and the nerve is not responding
to stimulation above and below the neuroma. The
neuroma was bisected and the nerve was refreshed
until the fascicles were seen inside the stump.
The distance between the parts of the nerve is
around 58 mm. The right sural nerve was
harvested and 4 bundles were gathered and
anastamoses of the nerve was achieved. Routine
closure of the wound after debridement of the
ugly scar. Smooth postoperative
recovery.
Follow Up
The patient came to the clinic 02-March-2003
with full power of the right biceps muscle and
the right triceps is 3/5.
The patient then came to the clinic 20-May-2003
with regression of analgesia to the fifth finger
right hand and the territory of the right
lower medial cutaneous nerve. The grip and
extension of the hand is 4/5. Extension of the
wrist is 3/5.
The patient last time seen 08-May-2004 with ECS
done 07-March-2004 telling that there is
improvement in comparison to the previous
records and there is no sensory loss at all, but
contracture of the MPJs of the hand is present
and he was advised to continue physiotherapy.
Comments
The patient underwent first surgery elsewhere
and there is no documentation about was found
and done.
Neurolysis of the affected nerves promoted rapid
recovery and the anastomosed ulnar nerve took
long time to recover.
Leica HM500
The World's first and the only Headmounted Microscope.
Freedom combined with Outstanding Vision.
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 .