18-APRIL-2026  AHAING KAMAL MUHYEDEEN  47 YEARS  INTRADURAL MENINGIOMA COMPRESSING THE SPINAL CORD AT D7-8 RIGHT ANTERIOR LOCALIZATION.

The patient a Kurdish citizen came to the clinic 15-February-2026 complaining of back pain with exacerbation last 2 months. MRI lumbar spine done 17-July-2025 showing bulge disci D12-L1, L1-2 and L2-3.

On examination, the patient is not limping with no scoliotic stances. SLRS right side was 40 degrees and 40 degrees in the left due to weakness. There is weak dorsiflexion both feet 4/5, both quadriceps muscles 4/5 and iliopsoas muscles 3/5.

The patient was sent for investigation and MRI dorsal spine showed a mass at the level of D7-8, for what more investigations done confirming meningioma  pushing the spinal cord to the right and posterior. SVS ruled out malignancy of the lesion and fibertraking demonstrating absence of the fibers below the lesion.

The patient then came 15-April-2026 asking for surgery. The patient had flue 2 weeks ago and ESR done today showing 25 mm/h. The liver enzymes are elevated and the anesthesia group was informed to adopt the anesthesia protocol. She developed allergy to Vancomycin, which was stopped.

Prone position. The level of D7-8 was counted from the L5 and up identified and right sided laminectomy of D7-8 was done. The dura was seen and the dura opened at the tumor site. There is no evidence of tumor, for what the patient was sent to MRI to check the level. The tumor was abutting the lower border of the surgical field for what the laminectomy was extended 5 mm inferior and so opening the dura. The tumor was seen and it was easily removed and sent for histologic verification. The dura was closed. Due to liver problems, there was massive profound bleeding more from the bone, for what a lot of wax was used.  She was given 3 units of blood and 4 units fresh frozen plasma, The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. Tight water tight closure of the wound. Routine closure of the wound. The patient showed deterioration of the right upper limb. She was sent to the ward.

The patient started to recover the strength of her right leg the next day.

The histologic result was psomamatoud meningioma benign.

The patient is walking with assistance and with slight improvement of the right proximal muscles right leg after deep worsening immediately after surgery. Defecation and urination intact. The left leg dramatically improved.

The tumor was causing weakness of proximal muscles of the legs with preservation of the sensory paths.

This is the 299th case using the MultiGen. This procedure regained routine acceptance.  It became a usual part of the spine and peripheral nerves surgery. Click here for reference. The patient showed improvement of the motor stimulation after BPRF and the sciatic pain disappeared and regained almost normal power of the left foot.

With accumulation of data, it became clear that the irritated nerve with aberrant currents running in the C fibers up, not only causing no change or elevation of the required voltage to achieve motor response, but they could cause the preoperative weakness. Ablation of such currents results in facilitation of the motor response and improvement of function with disappearance of pain.

It is unclear why the roots have several motor response with different patients, despite the fact that the neurological status was the same and the anesthesia protocol also the same.

It could be that the nerve is recovering minute by minute after decompression and this can explain why the motor conductivity is improving after the BPRF application, which require 5 minute session in most cases.

After the 172d case, the elevation of motor stimulation above 5 V was abandoned to avoid delayed dural tear with subsequent CSF leak, which take place at the contact at the lower electrode shaft with the dura below or above the level of the axilla.

Before doing motor stimulation in peripheral nerve surgery with tourniquet. always release the tourniquet before performing motor stimulation.

In this particular case the recurrence was related to her diabetes mellitus which caused swelling of the annulus fibrosis.