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22-JANUARY-2003 ABEL-AZZIZ ABBAS MUHAMED 51 YEARS
RECURRENT CHORDOMA OF THE SACRUM, L5, ILIOPSOAS MUSCLES AND ILIAC ARTERIES.
Comments
The different histologic results gave the
answer of chordoma, but clinically we are dealing with
chondrosarcoma. Total resection is impossible because the
running neural structures running inside the sacral bone are
also involved.
Anamnesis
The patient a Syrian citizen was operated by me
06-November-2000 for chordoma of the sacrum with
fixation of the spine with the iliac bones using
modified rods with preservation of the neural
structures running inside the sacro-coccygeal
region. He previously underwent radiotherapy.
The patient improved after the surgery and
CT-scan done 07-November-2000 showing remnants
of the tumor. 15-August-2001 started to complain
of pain right gluteal area and feeling heaviness
of the gluteal muscles.
The patient then came 21-October-2001 with MRI
of the pelvis done the same day showing
reduction of the tumor.
The patient then came 20-January-2003 telling
that his condition is deteriorating and CT-scan
showing huge recurrence of the tumor.
On examination: the patient in agonizing pain,
limping with exaggerated scoliotic stance. SLRS
was 40 degrees with pain right side and 40
degrees with more pain in the left. There is weak
dorsiflexion both feet 4/5 and planterflexion
left foot 4/5.
The old incision refreshed and
the tumor was followed and piece-meal resection of
the tumor was proceeded with drilling of the bone
around the lesion with preservation of the neural
elements. No CSF leak. Routine closure of
the wound. After the operation it seems that the
fixating device is insufficient, for what another
surgery was performed to aid the fixating device
with parallel rods to augment its strength. Smooth postoperative recovery.
The radicular pain decreased and the power of both
feet normalized. He was sent to the ward.
Follow Up
The patient then came 13-December-2004 telling
that the last week he cannot set or walk. SLRS
was 70 degrees both sides with pain. Normal
micturition and defecation, but drop right foot.
There is hypalgesia left perianal area. The
patient was sent for investigations and the
device is holding acceptable, but the tumor
recurrence in huge amount. The patient then
disappeared.
Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.
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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 .
