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The Shanghai Surgical Neurology International and Internet Journal edited by Nancy Epstein
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is an AI digital innovations in learning a new video journal all video interactive with discussion edited by James I Osman in association with Sub Saharan Africa Neurosurgeons are pleased to present
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the thirteenth as a monthly series of Sub Saharan Africa International Grand rounds in neurosurgery held on the first Sunday of each month
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These meetings are held to provide global solutions to clinical challenges in neurosurgery seen worldwide
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moderator and organizer this meeting as a strata Bernard
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assisted via James haussmann and given to an international audience in attendance
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The next presentation in this sub Saharan international Grand rounds is given by Professor Ma by deal which is the CICa Anta Diop university
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in Dakar Senegal in Senegal is located in Asia and the west side of Africa Dakar is it's capital as you can see located on the map in front of you
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Thank you for the presentation Dr Jami She'll Get I now share our one caves offer up to a KM any reason to stay in our units
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is twenty twenty twenty year old female with no particular medical history will have a good headache with a left Hemi better be any better these few days after the the headaches and she was admitted
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three weeks after the bleeding in our unit and she would classify that that belief in three an official treat
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the city showed these interim is very hematoma these little bit of a day Ma in the right frontal lobe and also a bit of bleeding in the the Corpus Callosum sister sister
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the enjoy City was done and rebuild this Aiken and the reason which she's up enter your projecting one and maybe
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on the junction between the A one and the left a one and a two junction
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since eg the Amazon was ruptured we decide food to treat her by and the only option available for US is a surgical option so we upgraded her after I found plenty of twenty six days after the bleeding
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the question was what would what should be the best approach for this was and the reason we we use for almost all of our patients have children are approached for a comment the reason I think it there
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was not this this is this is a dhamma and hematoma in the in the right frontal lobe I think I think we should go from the left side because MCM looks like the slice is oriented from the left to the to
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the right and the neck is maybe more reachable from the left side but since the patient had one already left him a bar this week we choose to go right side in order not to to create another problem in
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the In the left Hemi Semi soon
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so that based on either position vs a society slight it's extension of the head already has two allowing us to to to decompress and two to let the frontal lobe
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descending by the the gravity and not to to put a lot of iteration on the on the on the on the frontal lobe
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all our case You'd be stopped or located by the opening of the the Sylvian Julian Future I think it is very important to help a lot to do not to put a lot of nutrition on the frontal lobe and here you
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see the starting of the opening and you see the the yellow coloration signing the the Bleeding Amnesty during steam and now he arrived the the OPTO character John Cistern we are opening and draining
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some CSF Leeches which help us a lot to obtain the the Bran blended luxation and now we arrive onto onto the the object the red opting Nope we decided to direct made between the optic nerve under the
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annual rhythm you can the NSM come out into view here was Anterior projection and here we have to to to to be very careful not to dissect here before having the control of the vessel it may be
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sometimes very difficult and you have to go posteriorly to find the A one a one from the dead he said it's the knots side and also for the contralateral site
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now he has tried to tried to and he wants under the Andrews them
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by dissecting the Eric noted under the energies and now you can see
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the right a one going to the next and here you can see coming into his the left he won
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very important to dissect the day that he wants before before going to move to dissect the dome from the from the frontal lobe
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now reopening the interest of future little bit in order to find a way to go B to go behind any reason you do all that without temporary keeping you didn't use temporary temporary clipping for all our
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cases will be just if you saw that the the dissection would be would be possible without a temporary coupon clipping so we did that and now we're getting all the entering them around the dawn of the
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ones I edited around do any of them do and now you see here you have you have different arbiter from arbiter actually very stuck to that the animism and we'll have to do to observe
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the salmon is the the actually describing a loop and raced up to the to the enemy was on wall
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you have to to dissect that and to detect completely before putting a clip
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how you do it visa the dissector and your finances the visit wasn't just the Microsoft
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now that Archie is the depths
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it allow us to go to the desert to the contractor side to see the left have a tUs a to to be able to control where we are putting our cliff think is very important to control the the to a tos and if
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we can do the continental unit or so to be sure our clip will not compromise all that vessels here we continue the diocese dissection behind the the NSM Do
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and now you're trying to understand mosey honor to me before putting a clip
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sometime not very easy
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when you have
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more blips more than one bled for them here we have a second blurb here which is more proximal
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and now the first grip repeat is a pilot clip we put it in order to to continue the dissections is not defined a clip is a pilot clip which allow us to exclude those are just the most fragile part of
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the energy them in order to continue the dissection
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Yes Arizona is not the dome is not totally detached from the optic apparatus
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and will calculate the dawn
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after after the job is complete the best show you tried to put another clip in order to exclude all the all the all the dumb because the first clip is not
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is not really not the the best we can have because you have some part of the the neck which left behind so we replace the media gently adjust our our first clip to put it more proxy money
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in order to exclude all the ones that don't
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but this one clip will not be sufficient if You'd have to add another one the control that the patency of all the branches because our market up with a rope but here you see that we had won a blip
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here so we put a small clip on display and I think he's not doing any really good after that after after we detached the doom from all the searching we see that you'll have some neck here that was not
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not into the the clip blade so that was the final final clipping these three straight clip and here you have to put two traders are not too too too too too too long here because you can compromise the
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junction of the A one a to junk some of the left side
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because that was the operative video
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the patient had a bit worsening of her left hand body but it improved after few days she was discharged home after the the seventh postoperative day and when I saw her at the last photo at six months
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the no no look at the exam was normal
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The possibilities city showed this clip and no auditioning ischemia on complication thank you for your attention
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excellent that was very nicely done thank thank you so much for that presentation you really
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exemplifies many of the principles that Doctor valid because it talked about but but that Doctor Vasquez do you have any comments
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it was a very nice case you have any well then I guess I can't follow in the universal principles for the gut Microbiota Saturday I Guess
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Yeah I have one comment that that might be better useful also that some time Sir and we saw so in some experience to we have some experience on that case that when you calculate time to match the DOm
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the calculation can go even near to the nick of dynamics so it can produce a case of the
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rewriter in the future so it happened at the wicket of the few cases seen in Finland when we were when I was there saw there was an analysis of why a couple of patients that were operated under the
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cliff west very well blizzard so the half hour is roger and since we've had all be us there so we could analyze the videos and how as the strategy of the of the clip -in saw
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of course we we didn't definitively name it that that was the reason but we were thinking that one a risk factor for that may be the excessive calculation of the sack of donelson that can go even to
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the normal wall of the heart that he saw I think that that that is very important you should calculate just to reduce the size of that of the SEC but without going far in download a man was that
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sometimes you cannot recognize event but but the calculation can split little bitter but otherwise very nice case and yet you are using the serial number theory on that approach so but maybe also it
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could be through that later also probably that of roads but Yeah that in that case okay Thank You
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Jim Did You have any girlfriends thought it was an excellent job and very nicely just sector does they think I agree with I your homage demonstrated all the principles of exposing their anatomy and
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then gradually getting to the point where you're doing the clipping excellent job
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Yeah the very very well then I must Admit I think I might have been inclined to reset the Gyrus Rectus I admit that approach but fit very very very nicely done separate Dr Jose did you have a comment
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yeah actually this is a very nice and well I would say microsurgical principles the way of deception went to the blonde websites one doing the shopping section is very well demonstrated that I would
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enjoy and Yeah I can see the day that is that little bit of toxification on the exchanges authentic and that toilet Kate My initial opinion the document mentioning if he was okay this neck will need
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more than one clip because even though we can see the first or the second the club is not very close because that is a thickened neck in a way because of the classification that using multiple Tan
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Demo clips was was makes sense in this case in addition to the proximal a blurb it's well covered I I I really appreciate that and the two points here I think you mentioned digital sort of Testament
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to the importance and diagnosis some people call him get him to come on the flame he went on I I I think there is no much in the literature by the way on that if you search their literature you'll
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find only maybe one or two like series dedicated to this very famous sign that we all know that there is a Gyrus rectus him I don't want this means that it's almost butterfly monarch for a cum on your
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resumes and both those papers I think it's in the US and I published otherwise that is unknown much like long series Justifying as it to What a prognostic sign or not it's a sign that different region
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with regret or not is that a long term psychological effect based on that jet expectancy went down and there is nothing like that that that that a chair relax and focus of that time and it's threat
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even as an ideological assign that is known in inner cities for that just something to flag maybe for future research on interest and another point I if I time is that the orbitofrontal artery it
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swelled mention that how it's detected I think the same applied for the job electricity my Toma is the same for orbitofrontal if he was saturday literature on orbital frontal hematoma you will find it
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here and there and a common Eurozone theories but there is no papers on the orbitofrontal frontal are three is it safe to close it or not nobody said anything about that just check the literature you
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will see that I think that is the only one paid federally that name the orbitofrontal artery and and it's also published in this and I and in that paper we describe that in some cases especially with
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superior directing a call money orders and sometimes the ache we need to sacrifice that to automate your front door because it's the only existed in time for the Fisher because all the anatomical
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registration will describe the orbital frontal Arthur as going lateral from the a to actually it's from the fourth floor of a millimeter from the first four million meters of a two but on reality it's
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not going grotto it's going interior within the interim Mr Frederick Fisher so that will make it on the way of the Superior Aneurism on sometimes if it's a rupture in your resentment deodorant you may
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need to sacrifice that and our cities we try to preserve that there are three but in some instances we sacrifice and that has no effect and that was That i do have that paper that Okay we need more
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series focused on that the Arthur the sacrifice vs preserve whatever that function is not well described and I think you highlighted dwell and the operative video it's it's very nice done
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The figure in the other comment is actually excellent presentation so strata and we should go to DR amaro in an MA will have a presentation from you hope you enjoy this presentation
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