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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27-MAY-2015 ABDEL-AZZIZ RFEFAN AL-ENEZI 26 YEARS
RECALCITRANT WELL ENCAPSULATED ABSCESS LEFT LEFT SENSO-MOTOR STRIP.
The patient came to the clinic 25-May-2015
fro Saudi Arabia complaining of convulsions for
2 years with history of fever and headache with
right sided hemiparesis and hypalgesia for 2
months. MRI of the brain done 19-March-2015
showing huge cystic mass left fronto-temporal
area with massive edema. The patient was treated
for abscess and repeat MRI done 16-April-2015
showed dramatic shrinkage of the abscess. The
patient was discharged and came with fever to
On examination; the patient is complaining of
headache with nausea, blurred vision both eyes.
The patient is left handed and has right sided
hemiparesis 3/5 and hypalgesia.
The patient was admitted and repeat MRI of the
brain showed the abscess in the same region with
spectroscopy excluding the tumorous nature of
the lesion. The Choline is very low and the
lipids 1.3 and 0.9 are high. The patient was
covered with Vancomycin, Rocephine and Flagyl.
Cardiac consultation showed that the patient has
congenital defects , that G.A and hypotension
will be of great risk and high mortality.
Using RM (Riechert-Mundinger System), Inomed
Planning software and intraoperative MRI with
local anaesthesia, the abscess was reached fro
burr hole and using ventricular end of PS
Medical of shunt, the abscess was evacuated. It
was yellow brown thick in consistency and sent
for CXS and histologic studies. The wall of the
abscess was inspected it was a swollen brain
with no proper separable capsule. The cavity was
irrigated with saline and the ventricular tube
left in the cavity and connected to Ready-Vac
drain. The wound was closed and MRI after that
showed shrinkage of the cavity and the tube
hanging in the upper corner of the cavity.
The patient was sent for ICU for 12 hours for
The patient was operated without any
sedation with local anaesthesia using Xylocain and Marcaine.
The patient during surgery was in complete communication
that no neurologic deficit was noted, considering that the
abscess was in the left senso-motor area.
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
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Inomed MER system
The World's first and the only Headmounted Microscope.
Freedom combined with Outstanding Vision, but very bad video recording and
After long years TRUMPF TruSystem 7500 is running with in the neurosuite at
Shmaisani hospital starting from 23-March-2014
Spectroscopy ruling the presence of any malignancy.
High lipid and lactate inside the abscess.
Distribution of NAA showing complete destruction of neural tissue
inside the abscess cavity.
The capsule is the same as the abscess cavity.
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 .