Munir Elias 20-12-2013

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

Functional Neurosurgery
functionalneuro.surgery
Functionalneurosurgery.net

IOM Sites
iomonitoring.org
operativemonitoring.com

Neurosurgical Sites
neurosurgery.art
neurosurgery.me
neurosurgery.mx
skullbase.surgery

Neurosurgical Encyclopedia
neurosurgicalencyclopedia.org

Neurooncological Sites
acousticschwannoma.com
craniopharyngiomas.com
ependymomas.com
gliomas.info
meningiomas.org
neurooncology.me
pinealomas.com
pituitaryadenomas.com 

Neuroanatomical Sites
humanneuroanatomy.com 
microneuroanatomy.com

Neuroanesthesia Sites
neuro-anesthessia.org

Neurobiological Sites
humanneurobiology.com

Neurohistopathological
neurorhistopathology.com

Neuro ICU Site
neuroicu.info

Neuroophthalmological
neuroophthalmology.org

Neurophysiological Sites
humanneurophysiology.com

Neuroradiological Sites
neuroradiology.today

NeuroSience Sites
neuro.science

Neurovascular Sites
vascularneurosurgery.com

Personal Sites
cns.clinic

Spine Surgery Sites
spine.surgery
spondylolisthesis.info
paraplegia.today

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 .

29-JANUARY-2015  TURKEY KHALAF MUHAMMED  4 YEARS  HUGE MEDULLOBLASTOMA WITH EXTENSION TO BOTH FORAMINA OF LEUSCHKO.

 

Anamnesis

bullet

The patient came to the clinic with his parents 27-January-2015 complaining of vomiting and drowsiness for 1 month with the last weak complaining of diffuse headache. CT-scan done 25-January-2015, showing a midline posterior fossa mass.

bullet

On examination, Considering his age, it was difficult to evaluate him for Romberg positioning, but there was no nystagmus and neurologically was free.

bullet

The patient was admitted urgently to the hospital and MRI of the brain with contrast with MRA of the brain and carotids with spectroscopy and DTI were performed under G.A. There is huge medulloblastoma vermian localization with extension to both foramina of Leuschko. So as to avoid putting shunt to him, massive doses of Decadron were started and the patient started to improve.

bullet

Midline posterior occipital approach in setting position. The bone flap reflected to the neck inferior. The dura was opened in V-shape fashion. The tonsils were shifted downward and the vermis is prominent by the tumor. Sharp dissection of the inferior pole of the vermis ( The uvula). The tumor was highly vascular with rich blood supply. The tumor was coagulated sucked and most of the upper part was removed. The inferior part was was removed until the  obex with related structures were seen. The left part of the tumor was followed and resected until the foramen of Leuschko was seen and the left inferior cerebellar peduncle was preserved. The same maneuver was undertaken in the right side. The tumor inside the 4th ventricle was removed and the floor of the 4th ventricle was seen intact with widened aqueduct through which the third ventricle was seen. The superior medullary velum was respected. The floor of the 4th ventricle was flattened due to the previous compression effect of the tumor, that it was impossible to see the median sulcus, nor the paramedian sulci limitantes or the hypoglossal trigone elevations at the calamis scriptorius. I got the impression that the tumor was totally resected, for what intraoperative MRI control with contrast was done. There is still part of the tumor in the right upper corner and the right foramen of Leuschko. Resection of this part was achieved until the normal cerebellar tissues were seen at these angles. Strict hemostasis with water-tight closure of the dura and bone flap was secured with 2 stitches and routine closure of the wound.

bullet

Smooth postoperative recovery. The patient extubated and sent to the ICU for 24 hours observation.

 

 

Comments  

bullet

The patient has typical spectroscopic data supporting medulloblastoma. The histologic result will give the answer.

Skyra MRI with all clinical applications in the run since 28-Novemeber-2013.

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


Inomed MER system


Spectroscopy showing typical data for medulloblastoma


Choline distribution in the medulloblastoma.


Cho/NAA ration distribution of the medulloblastoma.


Floor of the 4th ventricle after removal of the medulloblastoma.


MRI done during surgery showing the missing part of the tumor, which was subsequently removed.

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

 


View Larger Map
 

© [2015] [CNS CLINIC - NEUROSURGERY - JORDAN]. All rights reserved