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
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21-APRIL-2009 SAYF EDDIN YAHIYA AL-MUFTY
76 YEARS HIGH GRADE ASTROCYTOMA RIGHT OCCIPITO-PARIETAL WITH
APOPLEXY 05-APRIL-2009.
Anamnesis:
The patient was admitted to
Shmaisani hospital 20-April-2009 with history of
sudden onset deterioration with admission to
other hospital and subsequent left side
hemiplegia.
The patient is a known
diabetic with hypertension and he underwent
several stents for coronary disease and Larische
syndrome.
MRI performed 05-April-2009
showed a tumor at the medial parts of the right
occipito-parietal region. The patient continued
to deteriorate and MRI of the brain performed
06-April-2009 showed the tumor with apoplexy
inside and outside the tumor. MRI of the brain
performed 19-April-2009 showed the tumor with
massive perifocal oedema with resolution of the
outside hematoma.
On examination: the patient
is drowsy and hallucinating with dense left
sided plegia with some movement of the left hand
and at times obeying commands.
Craniotomy at the right
occipito-parietal region was performed with
reflection of the bony flap down to the ear. The
dura was opened parallel to the occipital edge
of the bone defect. The hemorrhagic tumor was
reaching the surface of the cortex, for what,
transcortical approach was performed between tow
major running veins. The clot was evacuated and
the tumorous tissue was removed in piece-meal
fashion. Subtotal resection of the mass and
total resection of the surely looking tumor was
achieved. There was 20X20 mm defect in the bed
of the tumor through which the falx cerebri was
seen. The posterior horn of the lateral
ventricle was reached. Anatomical preservation
of the sensory strip and the optic radiation was
considered during resection. The
histological result was that of high-grade
astrocytoma. Strict heamostasis with applying
the surgicel in the tumor cavity. Water-tight
closure of the dura and routine closure of the
wound.
Smooth postoperative recovery
and the patient sent to the ICU without
ventilation.
Comments
The patient had mostly
malignant tumor which progressed hemorrhage.
This fact push to the malignant nature of the
tumor.
The next step is radiation
combined with temodar treatment. Gliadel wafers
could be an option for younger patients.
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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 .
