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
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01-DECEMBER-2008 ALI SALEM AL-HIYASAT 80 YEARS CHRONIC SUBDURAL
HEMATOMA LEFT CEREBRAL HEMISPHERE.
The patient was admitted to
the Shmaisani hospital 29-November-2008 with
clinical history of minor trauma 2 months ago
and ataxic gait for 10 days.
The patient has esophageal
diverticulum for long time and cardiomegaly, but
not under treatment.
CT-scan of the brain done 3
days ago at Issra hospital and the day of
admission, confirming the presence of huge
chronic subdural hematoma over the left
On examination: the patient
has right sided hemiparesis more in the distal
muscles and some elements of frontal lobe
syndrome. Otherwise he was neurologically free
except for ataxic gait due to paresis.
Burr hole in the left
parietal region was performed and washing of the
hematoma was performed. It was more resembling
hygroma in consistency and insertion of external
drain was performed.
Smooth postoperative recovery
and the patient was sent to the ICU with the
external drain kept at low level and the patient
was asked to keep in the left sided position to
allow further draining of the remaining
Chronic subdural hematomas or
hygromas usually occur at the old age and they
are all the time associated with minor trauma
and manifest themselves clinically after 1-4
month after the insult.
Most of the time creation of
one burr hole with insertion of the drain to the
most inferior point of the hematoma cavity
resolve the problem.
Usually a little amount of
collection remains and it resolves over the time
within several weeks. It happens that
reaccumulation take place, then double burr
holes are used or craniotomy depending upon the
thickness of the hematoma wall. This last
scenario have place in around 10% of cases.
Washing during surgery of the
hematoma cavity helps in breaking the osmotic
mechanism, which trigger the hematoma formation,
for what washing is considered an integral part
of the operation.
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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 .