Inomed Stockert Neuro N50. A versatile
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Multigen RF lesion generator .
18-DECEMBER-2002 WASFIYEH ISSA JEKAT 60
YEARS GLIOBLASTOMA MULTIFORME LEFT FRONTO-TEMPORAL LOBES.
Comments
The Glioblastoma multiforme is the most
malignant brain tumor. The prognosis is gloomy.
At the present time, I will not operate
the patient with Glioblastoma multiforme without proper MRI
and MR Spectroscopy and Fibertraking and intraoperative MRI
monitoring and electrophysiological control and to have in
advance Gliadel wafers and seeds for brachytherapy. With
these measures you can elevate the postoperative life
expectancy for around 5 years as in the future surgeries.
(06-May-2021).
Anamnesis
The patient was brought to the clinic 11-December-2002
complaining of right sided plegia, motor and
sensory aphasia for one month. The condition is
rapidly deteriorating with nausea and vomiting.
She had hearing loss right ear for long time.
MRI with contrast showing huge mass left
fronto-temporal lobes extending deep to involve
the mediobasal temporal lobe and sensory
auditory area and the left internal
capsule with massive edema shifting the midline
structures to the right. PET was done showing no
tracer activity. There is enlargement of the
right lobe of the thyroid gland. The patient was
put in medications to improve her condition and
repair for surgery.
On examination: The patient is not responding to
verbal command, nor speaking. Dense right sided
plegia.
Wide left osteoplastic craniotomy over the left
frontal and temporal lobes. The dura opened
parallel to the bony edges and with the bony
flap reflected to the ear. The Sylvian cistern
identified and the motor strip , Broca area and
the sensory auditory area also identified. It
was decided to attack the tumor first through
the temporal lobe, then transcortical prefrontal
and piece-meal resection of the tumor was
performed. Fresh frozen biopsy gave the result
of Glioblastoma multiforme. After that it was
decided to remove as possible as can permit, so
as avoid loosing the patient in operating room.
The tumor was attacked through the temporal lobe
away from the sensory auditory area and
resection was performed with preservation of the
MCA branches. It was possible to see the
olfactory tract running at the base. Alternative
resection was performed from these two
approaches. The swollen brain collapsed and
pulsating and CSF coming from the Sylvian and
prechiasmatic cistern. It was possible to see
the left optic nerve running under the olfactory
tract. Strict hemostasis and routine closure of the wound.
Smooth postoperative recovery.
The neurological status still the same .
She was sent to the ICU for strict observation.
Follow Up
The patient was sent for radiotherapy and
chemotherapy.
The final histologic result was Glioblastoma
multiforme. ( Dr. Hussam Abu-Farsakh, M.D.)
Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.
Inomed Riechert-Mundinger System, with three point
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Inomed MER system
Leica HM500
The World's first and the only Head mounted 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
LooksCam II Xenosys in the run starting from 14-March-2021 with
SheerVision TTL x4 magnification.
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 .