TRUMPH TruSyatem 7500

Dr. Fuad Al-Masri Syrian neurosurgeon.

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.fr

Functional Neurosurgery
functionalneuro.surgery
Functionalneurosurgery.net

IOM Sites
iomonitoring.org
operativemonitoring.com

Neurosurgical Sites
cns.clinic
cns-online.com
cns.surgery
cns.today
e-neurosurgery.com
neurosurgery.ag
neurosurgery.bz
neurosurgery.co
neurosurgery.cz
neurosurgery.fr
neurosurgery.gallery
neurosurgeryvideo.gallery
neurosurgicalvideo.gallery
neurosurgery.guru
neurosurgery.me
neurosurgery.mx
neurosurgery.photos
neurosurgery.tips
neurosurgery.me
neurosurgery.tw
neurosurgeryspine.org
skullbase.surgery
spine.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
glioma.ws
meningiomas.info
meningiomas.org
neurooncology.me
neurooncology.tv
neurooncology.ws
onconeurosurgery.com
pinealomas.com
pituitaryadenomas.com
pituitaryadenoma.net
schwannomas.com
theneuro-oncology.com

Neuroanatomical Sites
diencephalon.info
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
e-neuroradiology.com
neuroradiology.ws

Neurovascular Sites
vascularneurosurgery.com
vascularneurosurgery.net

Personal Sites
cns-clinic.net
cnsclinic.org
munirelias.com
munir.ws

Spine Surgery Sites
spinesurgeries.org
spinesurgery.ws
spondylolisthesis.info
paraplegia.co
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 .

 

Anamnesis

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A Syrian gentleman 58 years came to the clinic 05-11-2004 with complaining of right oculomotor plegia. He was referred as a case of meningioma and he was sent for more MRI and MRA investigations, which confirmed the diagnosis of right posterior clinoid meningioma. The patient start to complain of Diplopea for 2 days then the last 2 weeks progressed complete right oculomotor plegia. The patient was admitted to Al-Shmaisani hospital 09-11-2004 and was operated the same day.

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Wide right fronto-temporal approach with tranzygomatic route was achieved and the tumor was morphologically identical for meningioma with matrix and carpet of meningeal involvement. It was engulfing the supraclinoid ICA and pushing the M1 and the solitary A1 upward. The tumor was radically removed with preservation of all even tiny anatomical structures, including the anterior choroidal artery, the right PcoA, the right ICA, right optic nerve and the compressed right oculomotor nerve. The Liliquist membrane was opened for 2 mm distance to ensure that the oculomotor nerve was in continuity. No attempt was intentionally direct to explore the basilar and PCAs, to avoid manipulations and slipping of blood to that region. The operation was straight forward without any unusual events and the preliminary frozen section was suspecting the non-meningioma histologic verification, which could not be believed at that time. Even with this consideration total resection of the lesion was achieved. The patient awakened from G.A. He was sent to ICU and he was drowsy. The breathing pattern was acceptable, but he was aphasic with left side hemiparesis. Considering the smooth operation, CT-scan done immediately after operation and the CT-findings were acceptable. The next day, the condition was the same, for what another CT-scan done and showed massive infarction in the territory of both PCAa more pronounced in the right side. The patient despite vigorous efforts to treat the seemingly infarct area, progressed to deteriorate. Immunohistologic results were of highly malignant endocrine carcinoma.

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Considering that the patient was transferred from Syria , after putting him in ventilator in tracheostomy was performed 18-11-2004 to wean him off ventilator the next day. He was transferred to Syria 20-11-2004, and after some improvement, he was discharged to home to die 01-12-2004.

 

 

Comments

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Endocrine carcinoma is one of the most malignant tumors. It took here an aggressive course and the patient died within one month from the start of his illness. The strange point here to mention, that this tumor was unbelievable 100% grossly resembling a meningioma. The cascading catastrophic events also remain unexplained, since vasospasm was taken into account and precautionary measures were undertaken to prevent such event. The lesion was not related to the hypothalamus nor to the hypophysis. This interesting case is lacking more detailed investigations due to economic and geographic factors.

 

 

 

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MRI and MRA of the brain done 2 days before surgery, showing posterior clinoid meningioma growing parasellar directions with involvement of the right ICA, M1 and M2. The right optic nerve was pushed antero-medially and the right posterior communicating artery was pushed inferior and the compressed oculomotor nerve inferiorly was not involved. Notice that the left A1 was missing, making the surgical task more challenging. The anterior parts of the tumor was invading the right ICA and adherent to its wall and the anterior choroidal artery was pushed medial. CT-scan done the same postoperative day was uneventful, but the second postoperative day it showed massive infarction of the right occipital lobe due to remote spasm of the right posterior cerebral artery. The patient was given clexane 40 mg once and the third postoperative CT-scan showed petechial hemorrhages, for what clexane was decreased to 20 mg daily.

A. The immuno-histologic study of the endocrine carcinoma with syntaptophysin stain. B. The endocrine metastatic carcinoma with H&E2 staining. The study performed by Dr. Husam Farsakh. C. The immuno-histologic verification of the tumor with cytokeratin.

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

 

 

 

[2004] [CNS CLINIC - NEUROSURGERY - JORDAN]. All rights reserved