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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01-MARCH-2015 JAFAR MINJID AL-HASANAT 43 YEARS
PERSISTING CSF POCKET AFTER DISCECTOMY FOR L4-5 AND L5-S1.
The patient came to the clinic 26-February-2015
complaining of huge CSF pocket under the skin 10
days after performing discectomy L4-5 and L5-S1
25-January-2015 in UAE. He has attacks of
headache and fainting when changing the
position. It was drained twice, the last
On examination, the patient is not
limping with no scoliotic stance with
SLRS 75 degrees both sides with weak
dorsiflexion left foot 4/5 and hypalgesia left L5 and S1 roots.
When the patient was put in supine position with
coughing, the pocket raised more more than 3 cm.
A compressing dressing was applied.
The patient sent for investigations: MRI lumbar
spine done 26-February-2015 showing huge
CSF pocket communicating with the intradural
space more than 12 mm diameter at L4-5 and L5-S1
levels. Dynamic studies performed ruling out instability.
Lab investigations ruled out the presence of
The previous wound refreshed. A huge amount of
CSF came out. Hemilaminectomy L4 and L5 and
upper edge of the sacrum left side. Foraminotomy
L5 and S1 left side. The left L5 root is intact,
but there is recurrence of the extrusion which
was removed and further cleaning of L4-5 disc
space was achieved. The left S1 root was damaged
and torn. There are several torn points in the
posterior wall of the dura and slipped nylon
stitch 4 zero. The root was compressed by an
extrusion for what discectomy of L5-S1 was
performed. The tears in the posterior wall of
the dura were repaired by 6 zero nylon and the
torn root was also repaired. Still having oozing
CSF. A layer of lyodura with Glubran was applied
over the posterior wall of the defective dura.
There is still a tiny leak fro the lower corner
of the left S1 root. BioGlue was applied to that
corner and to several places to achieve
water-tight repair of the dural defects. The
head of the patient was maximally elevated and
Valsalva maneuver was applied. No CSF leak. Routine closure of the wound.
Smooth postoperative recovery.
The power of the left foot became normal.
The patient has a huge dural defects,
that will not close by time, instead they will harm the
brain. Surgical repair and water-tight closure is the best
The MRI data were misleading exaggerating
the dural defects. They were multiple and the main source
was the damaged left S1 root and tiny points near the
slipped stitch at the posterior dural wall.
Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.
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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
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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 .