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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26-OCTOBER-2011 NORA ZAKI ISMAEEL 24 YEARS
NON-FUNCTIONING LPS DUE TO UPWARD MIGRATION.
patient was admitted to Shmaisani hospital with
clinical signs of increased ICP. The patient is
a known case of pseudotumor cerebri and she went
4 surgeries for insertion of LPS, which all the
time is troubleshooting. The first surgery
was in November-2009, the second at
31-May-2011, the third at 22-July-2011 and the
last in 04-August-2011.
patient was sent for new MRI of the brain with
contrast and MRA and MRV, which all proved to be
normal. CT-scan of the abdomen at the primary
images gave little information about the status
of the device, but when using the ORSVisual
software, it became clear that the shunt was out
of the peritoneal cavity with upward migration
to the dorsal spine. Fundus photography showed
slight signs of papilloedema both sides.
The old incisions were refreshed and the old
upward migrating LPS was removed from the back.
Using Touhy needle, new LPS PSMedical Medtronic
was inserted about 20 cm intradurally. The
distal end was inserted intraperitoneally and
both points were fixed with anchors, included in
closure of the wounds. Smooth postoperative
CT-scan data reformatted by using ORSVisual software,
demonstrating the upward migrating device.
Please! wait for 3-5 min till the
video start to load. It depends upon the internet
Usually the LPS migrate downward. It could be
that this case is the first to be seen that the
device was migrating upward.
Why this happened remains unknown.
Fundi both eyes demonstrating slight papilloedema.
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 .