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 .
04-JUNE-2014 RIMAS RIYAD SALHAB 3 YEARS
POLICYTIC ASTROCYTOMA LEFT CEREBELLAR HEMISPHERE WITH VERMIAN AND TONSILAR
INVOLVEMENT.
Anamnesis
The patient came to the clinic 03-June-2014 with
the family, telling that the patient the last
month got headache with vomiting and fainting
attacks, ataxia and blurred vision. CT-scan done
today showing a mass with the diagnosis of
medulloblastoma.
On examination at the patient has no meningism,
nor nystagmus. The patient except for the above
mentioned complains was neurologically free.
The patient was sent for MR investigations with
MRS and DTI. The conventional MRI data and the
spectroscopy were in favor of policytic
astrocytoma.
In setting position, midline posterior approach
with reflection of the bone flap to the neck was
done. The dura was opened to expose both
cerebellar hemisphere more to the left. The
nidus of the tumor was fleshy violate and it was
possible to resect all of it and sent for fresh
frozen sections which confirmed the presence of
pilocytic astrocytoma. Total resection of the
cystic mass with its fleshy contents was
achieved. The vermian and the tonsilar
parts of the tumor were also included in the
resection. After strict hemostasis, the wound
was closed temporarily and the patient sent to
the MRI. There is air over the left cerebral
hemisphere and a suspected remnant near the
removed left tonsil. The patient sent back to
the operating table and in supine position, the
surgery was continued. The suspected mass in the
new MRI data was resected. Routine closure of
the wound.
Smooth postoperative recovery. The patient sent
to ICU for observation.
Normal brain MR Spectroscopy.
Spectroscopy of the intracyst material
Spectroscopy of the nidus material.
Choline distribution.
Creatine distribution
Lactate distribution
Choline/Lactate ratio.
The medulloblastoma shows low levels
of NAA, as well as elevated levels of Cho, lactate, and
lipids, and peaks assigned to taurine (Tau) and
guanadinoacetate (Gua). Pilocytic astrocytomas typically
have low levels of Cr, as well as elevated lactate in
this example. As in adults, high-grade astrocytomas show
increased Cho compared to low grade, while NAA is absent
in both examples.
Comments
MRS is a helpful tool to diagnose the
tumor before surgery.
Intraoperative MRI can confirm the
radical resection before closure and can show if there are
any other events in the brain nearby or remote from the site
of surgery. It can predict the postoperative care system of
the patient.
Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.
Leica HM500
The World's first and the only Headmounted Microscope.
Freedom combined with Outstanding Vision, but very bad video recording and
documentation.
After long years TRUMPF TruSystem 7500 is running with in the neurosuite at
Shmaisani hospital starting from 23-March-2014
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 .
