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14-JULY-2003 MUHAMED MISBAH ABU-JARAD 32 YEARS AVM LEFT
PARIETAL LOBE WITH SENSORY MARSH.
Anamnesis
The patient came to the clinic 08-July-2003
complaining of numbness of the right side of the
face and right upper limb for 15 months. Has
sensory marsh for what he is receiving Tegretol
without considerable effect, He has headache and
dysphasia for the last month.
On examination, the patient including the above
mentioned data has slight right hemiparesis.
The patient was sent for investigation and MRI
of the brain done showing high flow
arteriovenous malformation left parietal lobe
with multiple feeders, more from the left MCA.
The nidus is slightly subcortical with draining
veins running to the superior saggital sinus.
Before surgery angiography of
the brain was done with patient under G.A.
showing the AVM. Wide osteoplastic craniotomy to
expose the left parietal and the left sylvian
cistern was achieved with reflection of the flap
to the left ear. The dura was opened and the
pathologic veins were seen emerging fro the
nidus. Yasargil clip was applied for on of the
feeders and the nidus and draining veins were
coagulated. the nidus was followed and separated
from the normal brain tissues and the feeders
were coagulated. Total resection of the nidus
with coagulation of the feeding arteries was was
achieved. Strict hemostasis and angiography of
the brain showed the absence of the AVM. Routine closure of the wound.
Smooth postoperative recovery.
The patient progressed more right sided paresis.
He was sent to the ward.
FOLLOW UP
The patient
came 02-August- 2003 with clean wound with
right spastic paresis more the right hand area with
normal speech.
The patient
then came 09-December-2003 with normal speech and
full recovery of the right leg, but still having
right hand spastic paresis. MRI with MRA of the
brain performed 08-December-2003 showing no AVM and
the nidus cavity was filled with CSF.
The patient
after sending him to physiotherapy showed dramatic
regression of the spasticity of his right hand.
Comments
The AVM has many feeders that embolisation will
fail. Direct surgery in the case is golden
standard.
In retrospective analysis and revision of the
video recording, it was better to stuck near the
nidus and start from the larger feeders
and proceed from lateral near the sylvian
cistern the reach laterally the nidus and at
last the draining veins. (10-June-2021).
Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.
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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
LooksCam II Xenosys in the run starting from 14-March-2021 with
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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 .
Intraoperative angiography confirming total resection of the AVM.
