Dr. Ali Al-Bayati

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

The patient came to the clinic 08-April-2006 from YAR complaining of headache for 1 month with blurring vision, loss of concentration with difficult nominal memory with decreased hearing left side. She is in enalepril twice daily for one month. Her sister is pediatrician, and she was giving her mannitol 40 gm i.v 8 hourly, zantac 50 mg twice and decadron 8 mg 8 hourly. The patient was sent to MRI investigation and a mass in the left occipital lobe was diagnosed. On examination, the patient had only right sided paresis more in the distal muscles.

The patient was operated in the setting position. Considering the localization of the mass, which was near the calcarine artery and polycystic nature, and severe surrounding oedema, it was decided to attack the tumor directly through transcortical approach. This decision was made so as to avoid any traction injury to the visual structures. Considering the high upward expansion of the tumor, it was decided that supratentorial approach will not be the wise one. The tumor was found 20 mm under the surface and it had clear margins with rubbery blue-yellowish highly vascular consistency.

Radical removal of the tumor was performed without violating the posterior horns, preserving during that the calcarine artery, which was the main feeder of the mass. Intraoperative histologic verification, confirmed the presence of metastatic carcinoma, which will be exposed for further investigations for more accurate diagnosis.

Routine closure with smooth postoperative recovery.

For detailed theoretical references about metastatic brain tumors, click here!

17-April-2006: The final result of permanent and immunostaining studies was glioblastoma multiforme, since:

EMA was negative
Pancytokeratine was negative
Ki-67: 10%
GFAP was positive.

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