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Inomed Stockert Neuro N50. A versatile
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Multigen RF lesion generator .

16-OCTOBER-2019  ZAKI YOUSEF ASAAD  75 YEARS  HUGE SUBACUTE  SUBDURAL HEMATOMA LEFT CEREBRAL HEMISPHERE  WITH PROGRESSIVE RIGHT HEMIPARESIS.

 
 

Anamnesis

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The patient came to the Emergency of Shmaisani hospital the morning of 16-October-2019 with right sided severe paresis and motor and sensory dysphasia. The patient 45 days ago after RTA suffered fracture right tibia and screw fixation was applied. CT-scan at that time showed tiny subdural hematoma left parietal convexity. The patient condition started to deteriorate the last 2 days. CT-scan performed showed very huge subdural hematoma left cerebral convexity with slipping to the other hemisphere and shifting of the brain to the right side. The patient is diabetic with cardiomegaly with irregular pulse, in medication.

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On examination: The patient is bedridden with right sided paresis, motor and sensory dysphasia. Considering that he has cardiac problems, cardiologist was consulted.

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The patient before surgery was sent for MRI of the brain to rule out presence of vascular anomalies. The patient could not cooperate for investigation for what it was performed under general anesthesia. After induction and during the investigation, the patient showed severe hypotension, for what the investigation was halted for resuscitation. MRI of the brain was achieved before that and no vascular abnormalities of the brain were detected and the huge hematoma was more clearly seen. It was decided so as not to loose the patient to perform surgery. 

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Through 2 burrs at the left frontal and posterior parietal region, the hematoma was evacuated and external drain was inserted. The patient was sent to the MRI after performing surgery and the hematoma disappeared, but the brain still shifting and TWIST ruled out the suspicion of aneurysm of the aorta.

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The patient was sent to the ICU after extubating him and after 4 hours, he started to regain consciousness and the start to improve.

Follow Up

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The patient next day talking walking and understand the speech and eating. The patient will be kept in ICU for 72 hours after surgery.

Comments  

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The patient was during MRI under G.A in critical condition. Some told me to leave him, but considering that the evacuation of the hematoma is the only hope to jump him through this catastrophic event, it was decided to perform surgery.

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The hypotension attack after starting the G.A. could be due to cold environment of the MRI suite, or sensitively to certain drugs.

 

 

 

 

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 .

  

 

 

 

 

 

 

 

 

 

 

 

 

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