Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity.

Functional Neurosurgery
functionalneuro.surgery
Functionalneurosurgery.net

IOM Sites
iomonitoring.org
operativemonitoring.com

Neurosurgical Sites
cns-online.com
cns.surgery
cns.today
e-neurosurgery.com
neurosurgery.ag
neurosurgery.bz
neurosurgery.co
neurosurgery.cz
neurosurgery.gallery
neurosurgeryvideo.gallery
neurosurgicalvideo.gallery
neurosurgery.guru
neurosurgery.me
neurosurgery.mx
neurosurgery.photos
neurosurgery.tips
neurosurgery.tw
neurosurgeryspine.org
skullbase.surgery

Neurosurgical Encyclopedia
neurosurgicalencyclopedia.com
neurosurgicalencyclopedia.net
neurosurgicalencyclopedia.org

Neurooncological Sites
acousticschwannoma.com
craniopharyngiomas.com
craniopharyngiomas.net
ependymomas.com
ependymomas.net
glioma.co
gliomas.info
meningiomas.info
meningiomas.org
neurooncology.me
neurooncology.tv
neurooncology.ws
onconeurosurgery.com
pinealomas.com
pituitaryadenomas.com
pituitaryadenoma.net
schwannomas.com

Neuroanatomical Sites
diencephalon.org
humanneuroanatomy.com
medullaoblongata.info
mesencephalon.org
microneuroanatomy.com

Neuroanesthesia Sites
neuroanesthesia.info

Neuroendocrinologiacl Site
humanneuroendocrinology.com

Neurobiological Sites
humanneurobiology.com

Neurohistopathological
neurorhistopathology.com

Neuro ICU Site
neuroicu.info

Neuroophthalmological
neuroophthalmology.org

Neurophysiological Sites
humanneurophysiology.com
neurophysiology.ws

Neuroradiological Sites
neuroradiology.ws

NeuroSience Sites
neuro.science

Neurovascular Sites
vascularneurosurgery.com
vascularneurosurgery.net

Personal Sites
cns.clinic
cnsclinic.org
munirelias.com

Spine Surgery Sites
spine.surgery
spinesurgeries.org
spondylolisthesis.info
paraplegia.ws

Stem Cell Therapy Site
neurostemcell.com


Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
countless applications and many uses


Multigen RF lesion generator .

27-NOVEMBER-2016  RAMI SALAH AL-NAJDAWI  30 YEARS  RIGHT BRACHIAL PLEXUS NEURITIS WITH AGONIZING PAIN.

 

Anamnesis

bullet

The patient came to the clinic 26-October-2016 complaining of weak right upper limb for 30 days with agonizing pain of the right upper limb and discoloration of the right side of the tongue and cramps of the left little toe. MRI performed 16-October-2016 was normal with EMG done 24-October-2016 confirming plexopathy.

bullet

On examination, the patient has intolerable pain of the right upper limb neuralgia like, that he is protecting her from any external stimulation. The right biceps muscle is 2/5, flexion right hand 2/5, extension 0-1/5, right triceps 2/5, There is hypalgesia of the right median and ulnar nerve distribution. here is no neck pain upon moving it. DTR D=S, no pathologic reflexes. There is pain upon palpating the right axillary artery. No frozen shoulder nor TOS. There is no myelopathic syndrome.

bullet

The patient was sent for neuro-radiologic evaluation and MRI of the right plexus and right shoulder were performed 30-October-2016 showing plexitis of the right brachial plexus at the level of the axillary fossa. All available lab investigations were normal.

bullet

With the patient awaken, with the right upper limb extended to expose the right axillary fossa, 4 catheters were inserted n both sides of the right axillary artery.  Bipolar motor stimulation of right brachial plexus was achieved with 1.2 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 240 msec duration to this segment was achieved using 2 bended catheters 10 mm exposed length. Further motor stimulation done to the same points and the response was 1.1 V with more brisk response. The same procedure was repeated 3 cm above the mentioned level lateral to the axillary artery to ensure more proximal branches. Bipolar motor stimulation of right brachial plexus was achieved with 1.2 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 240 msec duration to this segment was achieved using 2 bended catheters 10 mm exposed length. Further motor stimulation done to the same points and the response was 1.1 V with more brisk response. Bipolar motor stimulation of right median nerve was achieved with 1.7 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 240 msec duration to this segment was achieved using 2 bended catheters 10 mm exposed length. Further motor stimulation done to the same points and the response was 0.7 V with more brisk response. Bipolar motor stimulation of the right ulnar nerve above the cubital tunnel was achieved with 1.5 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 240 msec duration to this segment was achieved using 2 bended catheters 10 mm exposed length. Further motor stimulation done to the same points and the response was 1.4 V with more brisk response. Bipolar motor stimulation of right radial nerve from behind was achieved with 0.5 V. A bipolar pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 240 msec duration to this segment was achieved using 2 bended catheters 10 mm exposed length. Further motor stimulation done to the same points and the response was 0.7 V with more brisk response. This procedure was dictated by the patient feedback of his pain and it was continued until he became mostly pain free and the range of motion improved and the strength of the muscles dramatically improved.

bullet

He was sent to the ward for discharge.


MultiGen

 

Comments  

bullet

The patient has agonizing pain due to plexitis and all conservative measures to ease his pain failed.

bullet

This is the 94th case using the BPRF mode with MultiGen. This procedure regained routine acceptance.  It became a usual part of the spine surgery. Click here for reference.

bullet

It is the first case using this procedure in awake patient confirming that the procedure is effective and yielding good results without using Marcain or Depomedrol. Time will tell the length of the effect of this procedure.

bullet

It still unclear to evaluate the differences of pre and post application motor responses. The only sure thing that it tell that the electrodes did not migrate during the procedure and the nerve is functioning properly. Here there was no change of the threshold of stimulation power of motor stimulation after the BPRF in one root and improvement of the other.

bullet

With accumulation of data, it became clear that the irritated nerve with aberrant currents running in the C fibers up, not only causing no change or elevation of the required voltage to achieve motor response, but they could cause the preoperative weakness. Ablation of such currents results in facilitation of the motor response and improvement of function with disappearance of pain.

bullet

To my knowledge, it is the first case in human practice, that using such technique in brachial plexus neuralgia after neuritis giving an excellent result making the patient and the neurosurgeon happy.

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

Leica HM500
The World's first and the only Headmounted Microscope.
Freedom combined with Outstanding Vision, but very bad video recording and documentation.

TRUMPF TruSystem 7500

After long years TRUMPF TruSystem 7500 is running with in the neurosuite at Shmaisani hospital starting from 23-March-2014

 


Axillary fossa anatomy showing the relation of the brachial plexus and its relation to the axillary artery.


Schematic drawing showing the effective areas of the fields in bipolar mode of BPRF.

Back Up!

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 .

  

 

 

 

 

 

 

 

 

 

 

 

 

WELCOME TO AL-SHMAISANI HOSPITAL

 

 

 

[2016] [CNS CLINIC - NEUROSURGERY - JORDAN]. All rights reserved