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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21-MAY-2013 KHADIJEH JUMAA JASEM 50 YEARS
ADENOCARCINOMA OF THE CAVERNOUS SINUS RIGHT SIDE.
The patient came
to the clinic 19-May-2013 complaining of right
ophthalmalgia, diplopea, decreased vision right
eye, photophobia and numbness right side of the
face for 4 months. Right otalgia for 2 months.
She was operated and radiated for adnocarcinoma
of the nasal cavity during the last three months
of 2009. Radiation dose was 3300 rad during
October-2009. The patient in Rivotril 1 mg twice
daily for several years for right trigeminal
On examination: The patient has hypalgesia
I-II-III divisions of the right V nerve.
Blepharospasm of the right eye due to
photophobia. Decreased vision right eye. The
oculomotor and the trochlear nerves are
functioning well. The uvula shifts to the left
and there is scareous changes in the right side
of the soft palate.
The patient sent for new MRI of the brain with
contrast with MRA of the brain with special
sella protocol, which were done 20-May-2013
showing the mass involving the right cavernous
sinus pushing the arterial compartment medially
and reaching the right optic canal, compressing
the optic nerve. CT-scan of the chest and
abdomino-pelvic cavities done 10 days ago were
normal, so the bone scan done 20-May-2013
showing only the high uptake at the mentioned
lesion of the cavernous sinus.
Right extended pterional
approach with reflection of the bone flap to the
right ear. The dura was opened parallel to the
anterior and middle fossa. The right cavernous
sinus, the right optic nerve. the supraclinoid
right ICA and the olfactory tracts were seen
after opening of the sylvian cistern. The tumor
was invading the lateral wall of the cavernous
sinus. 8 mm under the superior edge of the
cavernous sinus, a dural incision was done to
expose the tumor. Piece meal resection of the
tumor was carried out and fresh frozen section
confirmed the presence of malignant
adnocarcinoma. Considering that the tumor was
invading all the branches of the right
trigeminal nerve, the incision was widened to
expose most of the tumor leaving the above
mentioned zone of 8 mm to avoid injury to the
right oculomotor and trochlear nerves. A bundle
of nerves, which mostly is a division of the
ophthalmic division of the trigeminal nerve was
violated. A wide cavity was created at the tumor
bed and the dura was seen at the bed of the
resected tumor. The CSF flow started to come
from the posterior parts of the cavity,
mandating no residual at the posterior aspect.
At the anterior part of the cavity, further
resection of the mass revealed that the tumor is
transforming to nerve bundles, for what the
resection was limited. Inspection of the right
optic nerve and supraclinoid and the space
between them revealed no tumor at these angles.
Surgicele was inserted at the tumor bed cavity
and routine closure of the wound.
Routine closure of the wound.
Smooth postoperative recovery. The patient was
sent to the ICU.
The patient has adnocarcinoma treated 4 years
ago and has spread to the right cavernous sinus.
Surgical resection, followed by radiotherapy is
the best option at this time.
The tumor was diffusely invading the neural
structure of the trigeminal nerve. They were
included in the resection to obtain maximum
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