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
Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses
Multigen RF lesion generator
26-OCTOBER-2012 MARIAM ABDEL-RAHEEM BA-SALAMA 62
YEARS ARNOLD-CHIARI MALFORMATION II-III DEGREE.
The patient came to the clinic 24-October-2012
complaining of fainting attacks with neck pain
and pain both upper limbs for 18 months. She is
also complaining of LBP and numbness both feet.
MRI brain done 17-October-2012 showing
Arnold-Chiari malformation. Cervical MRI showed
the same tonsilar herniation reaching the level
of mid of C2 and several disci, the most
prominent was C6-7. MRI lumbar spine showed
extruded disc L4-5 more to the left with
secondary stenosis with old wedge fracture L2 of
no clinical significance.
On examination: the patient is limping with
preserved sensori-motor status of the upper
limbs, but exaggerated deep reflexes. There is
weak dorsiflexion both feet 3/5 with weak
quadriceps right -4/5 and left 4/5.
The patient was sent for MRI of the dorsal spine
and dynamic studies, which were performed
25-October-2012 and they were uneventful.
Decompressive laminectomy C1
and C2 with drilling of the posterior rim of the
foramen magnum with exposure of the dura over
both cerebellar hemispheres. The dura was opened
in Y-shape fashion to expose the tonsils and the
spinal cord with the running vermian branches of
PICA both sides. The arteries were full of
calcification. Using microscopic facilities,
dissection of the arachnoidal bans tethering the
tonsils were bisected with preservation of all
the minor arterioles and veins. Using dural
graft, adopted to the dural defect, it was
stitched to obtain water-tight closure of the
dura, using 6 zero nylon.
Routine closure of the wounds. Smooth
postoperative recovery. The power of both feet
Please! wait for 3-5 min till the
video start to load. It depends upon the internet
The patient has several
problems: Arnold-Chiari malformation and PLD
L4-5 and small cervical disci. The first 2
conditions require surgery, but precedence must
be paid to the Arnold-Chiari malformation.
The patient has no syringomyelia, for what no
attempt was done, intentionally to reach the
The World's first and the only Headmounted Microscope.
Freedom combined with Outstanding Vision.
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 .