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 .

16-AUGUST-2017  MUHAMED SALMAN AL-ABED  50 YEARS  HUGE EXTRUDED DISC L5-S1 WITH DISCITIS AND OSTEOMYELITIS OF THE LOWER PART OF L5 AND UPPER PART OF S1.

 
 

Anamnesis

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The patient came to the clinic 14-August-2017 complaining of LBP with right sciatica for 3 months, then progressed to be bilateral sciatica more the right the last week down with numbness right S1 territory.

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On examination, the patient is in agonizing pain, limping with exaggerated  scoliotic stance. He cannot set in chair due to pain. SLRS was 40 degrees with pain in both sides. There is weak dorsiflexion both feet 3/5 and planterflexion right foot 4/5.

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The patient was sent for investigations and MRI lumbar spine performed 14-August-2017 showing very huge extrusion L5-S1 with right downward migration. Dynamic studies ruled out overmobility, but the lower border of L5 and upper border of S1 are eroded due to osteomyelitis. Lab investigations showed ESR 55 mm/h. CRP was 29 mg/L. CT-scan of the area confirmed the presence of erosion and showed fatigue fracture of both isthmi of L5 lamina. The patient was admitted urgently to surgery.

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Foraminotomy of both S1 roots was achieved with preservation of the spinous processes and intra-spinous ligament to avoid increasing the possible postoperative instability. The extruded disk was removed from both sides and the material was sent for histological and CXS studies. After that Vancomycin 500 mg twice a day was immediately started. Using MultiGen, bipolar motor stimulation of the right S1 was achieved with 2.3 V. Bipolar motor stimulation of the left S1 was achieved with 1.4 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to both S1 roots was achieved using 4 bended catheters 10 mm exposed length. Further bipolar motor stimulation of the right S1 was achieved with 1.7 V. Bipolar motor stimulation of the left S1 was achieved with 0.8 V. Routine closure of the wound.

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Smooth postoperative recovery. The power of both feet normalized and he was sciatica free. He was sent to the ward.


MultiGen

 

Comments  

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The patient has huge extruded disc with discitis and osteomyelitis adjacent vertebrae. The cause of such event is still open and needs clarification for proper post-operative planning.

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This is the 132d 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 the threshold of stimulation power of motor stimulation of the root after application was better.

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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 minute session in most cases.

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

 


CT-scan confirming erosion of the bones and fatigue fracture both isthmi.


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 .

  

 

 

 

 

 

 

 

 

 

 

 

 

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