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 .

14-OCTOBER-2017  ODEH RAMADAN SALEM  46 YEARS  RECURRENT DISC L5-S1 WITH RIGHT DOWNWARD MIGRATION.

 
 

Anamnesis

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The patient was operated by me 24-July-2007 for extruded disc L5-S1 right side with foraminal occlusion. he patient then came several times to the clinic complaining of right and other times left sciatica. Postoperative MRI done several times confirming no recurrence of the disc with dehydrated disc L3-4. The patient then came 14-September-2017 telling that the last 2 months got right sciatica down to the lateral aspect right ankle joint. MRI performed 27-August-2017 showing extruded disc L5-S1 with right downward migration. The patient underwent cath and stinting 2011 and 2012.

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On examination, the patient is limping with exaggerated scoliotic stance. SLRS was 45 degrees in the right with pain and 70 degrees in the left with tightness. There is weak dorsiflexion right foot 4/5 with hypalgesia below L1 level?

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The patient was sent for investigations and dynamic studies ruled out overmobility. The patient was advised to stop anticoagulants and to be seen by cardiologist.

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Refreshment of the old wound and neurolysis of the right S1 root. Foraminotomy of right S1 root was achieved. The extruded disk was removed lateral to the axilla from right side. Right sided intradiscal cleaning of L5-S1 disc space was performed. For the future project, an hexagonal Allen key No 4 was easily going inside the annulus fibrosis defect, but No 5 was possible with slight resistance. Using MultiGen, bipolar motor stimulation of the right S1 root was achieved with 1.7 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 msec duration to the right S1 root was achieved using 2 bended catheters 10 mm exposed length. Further bipolar motor stimulation of the right S1 was achieved with 1.6 V. Routine closure of the wound.

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


MultiGen

 

Comments  

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

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This is the 137th 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

 


 

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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