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

Functional Neurosurgery

IOM Sites

Neurosurgical Sites

Neurosurgical Encyclopedia

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Neuroendocrinologiacl Site

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Neuro ICU Site


Neurophysiological Sites

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NeuroSience Sites

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Spine Surgery Sites

Stem Cell Therapy Site

Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses

Multigen RF lesion generator .





The patient was operated by me 08-July-2000 for PCD C5-6, c6-7 with fusion of C5-6-7 and was doing well. The patient then came to the clinic 01-February-2017 complaining of LBP for 1 day with bilateral sciatica.  The patient has diabetes mellitus for 1 years and had stinting 21 years ago.


On examination, the patient is limping with exaggerated scoliotic stance. SLRS was 10 degrees right side with pain and 5 degrees in the left with more pain. There is weak both feet dorsiflexion 4/5 and planterflexion both feet 4/5. There is pain both hips and SIJs.


The patient was sent for investigations: MRI of the pelvis was normal, The MRI of the lumbar spine showed the extruded disc L4-5 with right right upward migration and segmental stenosis. Dynamic studies showed minimal spondylolisthesis L4-5. ESR was 35 mm/h and CRP was 8 mg/L. he patient was sent for cardio evaluation and Zinnat started 500 mg twice daily.


Decompressive laminectomy of L4 and upper part of L5 was done,  foraminotomy both L4 and L5 roots both sides. The extruded disk was removed lateral to the axilla of the right L5 root extending far up. Right sided cleaning of L4-5 was performed. Inspection of the annulus fibrosis from the left side was uneventful. Using MultiGen, bipolar motor stimulation of the right L4 was achieved with 1.1 V and the left side with 0.9 V.  The right  L5 root was achieved with 1.6 V and the left one with 2.0 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to both L4 and L5 roots both sides was achieved using 4 bended catheters 10 mm exposed length. Further bipolar motor stimulation of the right L4 was achieved with 0.9 V and the left side with 0.9 V.  The right  L5 root was achieved with 1.6 V and the left one with 2.2 V with more brisk response. Routine closure of the wound.


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






The patient still having an estimated postoperative recurrence around 7%, because the disc space is still not shallow.


The minimal spondylolisthesis was ignored in relation to the big extrusion at the same level.


This is the 107th 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.


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 the same threshold of stimulation power of motor stimulation of the right L5, but the same for left L4 after the BPRF. The decrease of the motor response of the left L5 root could be explained by some shift of the electrodes?


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.


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 anaesthesia protocol also the same.


Diabetes Mellitus and old age in this case are the reason for relatively high voltage to regain motor response.

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


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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