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
neurosurgery.tv
Inomed Stockert Neuro N50. A versatile
RF lesion generator and stimulator for
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Multigen RF lesion generator .
19-AUGUST-2015
RAMZI GEORGE ISSA EMPYEMA AFTER REMOVAL OF THE RECURRENT HUGE LEFT
CONVEXITAL SUBACUTE SUBDURAL HEMATOMA.
Anamnesis
The patient was operated by me for recurrent subacute huge
subdural hematoma left convexity
26-July-2015 and the patient showed dramatic
improvement. The patient started to show surges
of high fever and pussy discharge from the
removed ready vac drain site. The discharge was
sent for CXS and E. Coli was identified. He was
covered with Tienam, Flagyl and Amikacin. The
discharge from the pin point site was continuous
and it was decided to wait until the pus subside
with daily dressing. The oozing stopped and the
fever disappeared, but the patient showed slight
deterioration, for what new MRI of the brain
done 17-August-2015 showing 2 locations of
empyema formation anterior to the craniotomy
defect and smaller one posterior at the pole of
left occipital lobe.
The anterior border of the previous skin
incision extended and burr hole inserted and the
dura opened. A huge amount of pus came out and
sent for CXS and a ready vac drain 14 inserted
so that the tip directed to the crista Galli.
The patient was sent for control MRI to check if
the other abscess in the occipital area
decreased in size. The anterior abscess
disappeared, but the occipital abscess still the
same. The patient was brought back to the
operating table and another burr hole was put in
the lower occipital area abutting the midline.
There is no abscess at this area. A titanium
clip was put and the patient was sent another
time for MRI control to see were exactly the
burr hole and the abscess. The abscess is
locating 2 cm above the created one. Another
burr hole was inserted and the dura was opened
and a huge amount of pus came out and sent for
CXS and a ready vac drain 12 inserted to this
cavity.
Smooth postoperative recovery. The patient was
sent to the ward. The power of the right hand
became better.
Comments
The patient progressed empyema, which
when it was oozing he was in acceptable condition. When it
stopped the condition of the patient deteriorated.
Cleaning of the empyema is the only
solution at this stage.
Intraoperative MRI was very helpful in
deciding the steps of the surgery and to provide to the
patient the most complete solution.
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
The World's first and the only Headmounted 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
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 .
