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22-SEPTEMBER-2010 AZIZAH ABDEL-QADER MAKKAWY 70
YEARS SUBACUTE SUBDURAL HEMATOMA RIGHT PARITAL REGION.
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to the clinic 15-September-2010 complaining of
headache for 7 days with epileptic attacks of
weak left upper limb for 4-5 min occurring 4-5
times a day. The patient suffered RTA
25-July-2010 without loss of consciousness. She
is a known diabetic for 5 months and
hypertensive for 1 year.
On examination: The
patient walking normally with stable stance. She
has weak grip and extensors of the left hand and
hypalgesia of the right hand. Tegretol was
started and sent for investigations.
MRI of the brain
showed subacute hematoma of the right parietal
region compressing the brain parenchyma causing
tiny cortical ecchymosis. CT-scan confirmed the
nature of the hematoma, which mostly was not
acute. The epi attacks stopped after starting
At the most
dependent point of the supposed to be chronic
subdural hematoma right parietal region, burr
hole was done. No hematoma is coming out.
The skin incision was widened and craniotomy of
the parietal region was done and the dura was
opened. The brain is swollen and no hematoma in
the field. The subdural fields were inspected
down to the tentorium and medially to the
SSS. No hematoma. The MRI data were several
times revised to check why there is no hematoma.
The report is telling that it is intracerebral,
but no convincing data at the field support the
report. The craniotomy was extended interiorly
to reach the senso-motor strip. There, the
hematoma was rubbery in consistency and subdural
in location, extracerebral with thick membrane.
It was resembling a meningioma with reactionary
changes to the dura around the lesion. All the
solid hematoma was removed with its thick
membrane and sent for biopsy.
Routine closure of
the wound and smooth postoperative recovery and
the external drain was left at the site of the
In old age patients with
presence of brain atrophy chronic and subacute
subdural hematomas can have place after
suffering even trivial trauma.
The epi attacks were due to
cortical irritation by the clot compressing the
It is rare to have this
difficult situation by 2 reasons: 1. The
hematoma localization was parietal in the MRI ,
but in reality it was over the sensori-motor
strip. 2. The hematoma was rubbery in
consistency and its removal was more difficult
than removing a meningioma.
Immediate postoperative control CT-scan
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 .