Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses
Multigen RF lesion generator .
17-SEPTEMBER-2019 FAYSAL AKRAM HAMADI 42 YEARS
CONUS MEDULLARIS TUMOR WITH EXOPHYTIC GROWTH MORE TO THE LEFT BEHIND L2-3.
Anamnesis
The patient came to the clinic 12-Sptember-2019
complaining of left sciatica with numbness of
the anterior aspect of the left thigh for one
month with progressive course and difficult
standing. MRI lumbar spine performed
11-September-2019 showing a mass behind L2-3,
bad quality with possible huge Tarlov cyst at
the sacrum more to the left.
On examination: the patient is not limping and
have no scoliosis. SLRS was 85 degrees both
sides without pain. There is weak left
iliopsoas, left quadriceps and dorsiflexion left
foot -4/5.
The patient was sent for MRI
evaluation , which was performed the same day
showing the mass fully circumscribed by the
spinal cord at its 80% of its upper part and
exophytic surrounded by roots in the lower part.
Spectroscopy of the lesion ruled out presence of
malignancy with lower level of choline and
absent NA and high lipid 1.3. MR Myelography
confirmed the huge Tarlov cyst full of CSF at
the sacral area.
Laminectomy L2, L3 and the
dura was opened in the midline and reflected. d
During arachnoid dissection
the tumor bulged out the dural defect.
Inspection of the upper and lower poles of the
cystic tumor. it became evident that it is
schwannoma with complete destruction of the
fibers. The attached accompanying motor root was
dissected off and preserved. The tumor was sent
for biopsy and SONOCA 300 was not needed to
perform resection. The distal and proximal
neural element was coagulated and complete
resection of the cystic schwannoma was achieved.
Water-tight closure of the dura using 6 zero
nylon after what hyperventilation, head up
position with Valsalva maneuver ruled out CSF
leak. Routine closure of the
wound.
Smooth postoperative recovery.
He was sent to the ward.
Comments
The tumor is reaching its maximum dimensions
and starting to show it self clinically. Surgical resection is
indicated to stop the escalation of the neurological
deterioration.
Due to severe compression of the tumor,
there was no epidural fat and the cystic tumor jumped out
after slight arachnoidal dissection.
Schwannomas usually arise from the
sensory roots, for what no response was achieved during
motor stimulation of the involved root.
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
its sensor gives feed back about the localization.
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
SONOCA 300
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 .
