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
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02-MARCH-2005 ZUBAIDA JURY HAFEZ 71 YEARS RECURRENT GIANT LEFT
A 74 year old lady came to the clinic
19-NOVEMBER-2004 complaining of weak left upper
and lower limbs for one month. The patient was
operated by me 23-November-1999 for left
acoustic schwannoma. She came at that time in
wheelchair with inability to walk with plegia of
the facial nerve left side and hearing loss. The
patient had exposure keratitis at that time.
Partial resection of the tumor was performed
through left retromastoid approach. The patient
showed considerable recovery of her gait and
power of her extremities. In 01-Mart-2005 the
patient was operated. Considering her age, she
was put in concord position to avoid air
embolism. Left transotic approach was performed
and a temporo-occipital bone flap was created.
The inner ear cavity was full of tumor. The
facial nerve was preserved and 90% of the tumor
The tumor was invading even the vertical and
horizontal part of the ICA, but it was
separable. The tentorium was involved, but all
measures were taken to preserve the superior
petrosal sinus. Tentoriotomy was avoided,
because with experience, all the patients, to
whom tentoriotomy was performed, resulted in
death due to herniation of the brain by gravity
and possible vascular reactions of the brain
stem , several days after what could be
considered successful surgery.
The patient showed prompt excellent
postoperative recovery and the strength of her
left side started to improve.
In old age patients the dura is severely
adherent to the bone. Taking that in
consideration , the sigmoid sinus was ligated
below the junction with the superior petrosal
sinus due to multiple tears, which were
Despite the preservation of the facial nerve, no
attempt was done to cross-anastamosis the nerve
with other nerves, due to long time of total
plegia of the facial muscles. The patient
performed tarsorrhaphy 1998. The patient is not
bothered with her looking. She is complaining of
inability to walk.
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