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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15-JUNE-2012 MAHMOUD IBRAHEEM KHALED MAHMOUD 58 YEARS
HUGE GLIOBLASTOMA MULTIFORME RIGHT FRONTO-TEMPORAL LOBES.
patient a Libyan citizen, came to the clinic
from Al-Hayat Hospital complaining of fainting
attacks and headache for 3 months and swallowing
problems. For one month start to show rapid
progression of left sided paresis, due to what
he suffered RTA one week ago and after that
progressed complete right sided plegia with
motor and sensory aphasia.
examination, the patient was brought in
stretcher, communication with difficulty with no
sensory deficit. The power of the right side is
MRI of the
brain done 16-May-2012 showing huge glioblastoma
multiforme occupying the right frontal and
temporal lobes. Even his son is a doctor, but
the total aphasia could be explained only by
that is he is left handed.
bureaucratic reasons the surgery was
delayed and the patient condition deteriorated
more, for what, another MRI was done
14-June-2012 to rule out the invasion of the
brainstem. Starting uncal conning was noted in
the new MRI.
Using INAV Medtronic and OPMI
Pentero 900, right fronto-temporal approach was
achieved with reflection of the flap to the ear.
Practical temporal lobectomy was done with the
rubbery consistency tumor was followed and
resected. Even the right sylvian cistern was
under visual control, a piece of the rubbery
tumor was left intentionally due to clustering
with right M1 and its branches to avoid possible
postoperative spasm. Broca area and the frontal
lobe looked healthy. The Wernicke area was left
untouched after resection of the rubbery part of
the tumor. That part extending to the internal
capsule was also respected and left behind.
Tease maneuvers were done with INAV. The
inferior horn of the temporal lobe was violated,
but surgicele was embedded there to prevent CSF
flow. The tentorium was inspected and the uncal
part was resected to avoid further uncal
herniation. 16 pieces of Gliadel wafers were
applied to the tumor bed and surgicele was put
over it to prevent its migration. Strict
heamostasis. About 90% of the surely tumor mass
closure of the wound. Smooth postoperative
recovery. The patient became more vivid and the
power of the left lower limb became better and
the patient is opening eyes and trying to
brain CT-scan done showing the extent of
resection and decrease of swelling .
Please! wait for 3-5 min till the
video start to load. It depends upon the internet
The patient has eminent
conning. Surgical decompression and application
of Gliadel wafers is the best option in this
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 .