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Welcome to the 17th SNI and SNI Digital Baghdad Neurosurgery online meeting held on September 4th, 2022.
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The meeting originator and coordinator is Samir Haase, University of Baghdad and Cincinnati
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The speaker will discuss Orbital Surgery Center in Medical City, Baghdad. The speaker is Dr. Hider A. Al-Hamiari, Department of Neurosurgery, Ghazi Hariri Hospital,
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Baghdad, Iraq.
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The introduction is by Professor A. Hadi Al-Khalili, the
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former chair of the Department of Neurosurgery at Baghdad University. Hi, I call
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on Dr. Hider, Vladimir Hameri, who is graduated from Baghdad Medical School in 1993
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and then he got his board in neurosurgery 2001 and he worked at Seshe Shaid Adnan as a attending consultant neurosurgeon and also added to his task he is carrying the task of orbiter surgery and he is
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leading the orbiter surgery center in Iraq in Iraq in fact the only center in the country. Please, Dr. Hayder.
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Good morning, good afternoon, good night for everyone. Thank you for your sharing out, sharing class, this presentation. My talk today, it is about the Orbital Center in Medical City, in
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Baghdad. This is the only orbital center which is available in our country, and it's receiving patients from all the governments. Now we will start to show you some historical review, founded by
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the
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prof Dr. Hadir Khaledi in the late of the 20th century, as the first specialized center in Iraq. It was started by the
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efforts of Khaledi, supported
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by the assistance of the specialist and other related speciality. This center at the beginning composed of outpatient clinic, orbital ward, about eight beds, four for male and four for female in
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addition to surgical theater. Later on, artificial eye lab added and be related to the center.
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Unfortunately, our prof Haliri couldn't complete his message due to the Iraqi invasion of the 2003 with its consequences.
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In spite of limitation in the resources at that time due to the blockade on the Iraq, but prof Haliri with his team able to help a lot of the patients. At about 2005, he forced to receive his
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mission with help of other workers in the team due to the obligatory travel of prof Haliri. Since that time, we are fighting to keep the center active under the recommendation of our teacher Haliri.
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Clearly our orbital world named by the name of the man was founded at the Haid al-Hali. And this is for the not Arabic people. This is his name on the world in Arabic.
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The center activity, the center received patients from all governance of the Iraq. The patients may have either surgical or medical problems, of course related to the orbit. The scene in the
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outpatient sent for investigation diagnosed and then
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threatened. Most
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of
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surgical problems represented by tumors, form body vascular disease, inflammatory disease infection and cosmetic correction. Most of the cases treated nowadays by transorbital approach with minimum
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need for transcranial one. Medical problems include pseudo tumor, thyroid of telemopathy and others. The center trained board students from neurosurgical, maxillofacial, ophthalmology and the
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plastic specialty and ENT
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present day. We see about 25 patients every week in outpatient clinic, a part of medical emergencies and consultation from other related speciality. About three to eight operations of the orbital
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intervention done every week, collectively about 75 to 80 patients per year. About 15 artificial eye done every two months.
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In our center, we have three patients with orbital involvement by nocal mycosis due to many causes, especially after COVID-19, saving about 90 from either inflation or exentration.
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This is a picture for one patient with orbital cellulitis. There was a there's a threading for vision and we have saved his vision. This is for a military person First, picture on the upper left.
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his photo before his injury. Later on, he was injured by a foreign body behind the eyeglob and the right upper photo. We did surgery for him. He came to me asking for inoculation because it is
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ugly and painful for him. We refused to do inoculation and we did surgery for him, removing the foreign body and this is the final result in the two pictures below.
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This is for another patient. It was female complaining for masks, compressing on the optic nerve and behind the globe. We did
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a type of surgery called by me, of course, modified lateral orbitatomy
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We did this surgery without opening the bone. and remove the cavernous hemangioma lesion on the right side.
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This is for another patient complaining from masks, compressing the optic and pushing the egg globe forward. It was a huge mask, lacrimal gland also excised totally.
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Artificial ILAP, our work in the lab greatly improved due to the experience that is gained with the time by our team from a lot of cases requesting our lab help. Of course, our country has exposed
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to a lot of wars and shells, injury, and this is leading to, unfortunately, loss of vision and eye-glove. Our team composed of six technicians.
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Last months, we started training in the field of replacement in the face, although primitive but promising. Of course, this is all by self-teaching. No training course at all. They keep watching
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on the
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YouTube and take experience from other private labs and they develop themselves for the better.
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This patient we did for her, artificial implant,
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Now I will show you my hour lab how it is working Thank you.
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clears throat
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This is another video showing final result after
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Hey
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Yeah. Yeah. Yeah.
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I published many literature about the orbital diseases and the complaint. Four of them, orbital hydrated disease, a case study of young patient with primary orbital lesion, orbital hydrated
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assessment of age, gender, site, distribution, and the clinical presentation. Comparative study between corticosteroid and metatroxide treatment for patients with orbital pseudotumor Assessment
11:58
of the factors reducing operative and post-operative lateral orbitatomic complication.
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Future vision, we're looking forward to make connections with the outside country to improve our experience and observing the advancement in this field as introducing orbitoscope in our work and
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improving the finishing of replacement. Thank you very much Thank you. Well, thank you so much. for this presentation and I was, and I'm now proud that you take the leadership of the center and
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keeping it so well and advancing it in a really a very good way. Thank you, sir. Thank you so much.
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Any question, any comment, please?
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Hari, I have a question. Do you know of many centers in the world that are doing this?
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No, no, no. Any centers, sorry, what? That are doing this kind of work? Not
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as center. In fact, our center probably is a unique, even all over the world because many oculoplastic surgeons, they do a wonderful orbital approach, orbital surgery, but not in a specific
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center. They do it either they are interested as an ENT surgeon interested or a much ill-ofacial interest. in this on oculoplastic, in general, plastic surgeon is interested in that, but not a
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center there where many specialties come together, maxillofacial, ophthalmologist,
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ENT, physician, when needed, all come together to do the work. So this is a unique center, I think. This I had there was saying that residents from different specialties, they come and train
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there Yes, of course. This is something great.
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Do you think it would be worthwhile to have Dr. Hader
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present this in surgical neurology as a report or paper or something, so that we can encourage other people to do the same thing? Indeed, absolutely. Yeah, of course need to support the fathers
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and then get some more experience from other centers.
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Dr. Hader, would you please take that as our suggestion. We welcome you to tell us in the world of what you're doing. Yes, we are pleased to do this and to share our experience to the others
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because you have a cumulative experience from the doing surgery for the dose patient. I, in our other country, maybe they have a go to one field of the operations, but we collect the patients from
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all fields and we did surgery for them. So we have a cumulative experience in this field. It's excellent, really excellent.
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Thank you.
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Dr. Haydar, if I may ask again, how many high-doted cysts you've seen all over these years?
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And these years, it's about 13 to 15 only. Yeah. From 2005,
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'06 to until now Because in my collection, I think more than. 20, 25, perhaps, high dietitist of the orbit at that time. So it's getting less in Iraq, I think. Yes, but the interesting, I
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have the case report, the
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age of the patient was five years. Yeah.
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And the impressing, it is mostly in children, the high dietitist. I didn't see high dietists in the middle light or old patient. At that time, I have many of them in an older age, yeah. Yes.
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Even one lady, I think, and had the
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'60s. Yeah, I actually think that when I practiced in Argentina where I trained, and then later in the Mexico, where I was chair of the department, we've seen, I thought it's this cerebellar,
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we have seen in the in the orbit. So although for the Western audience may seem like a strange or a rare problem from far away people, I don't know. It's a real problem. And also, as there is a
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constant flux of people, which is welcome, then we will start seeing more, I thought it's Stephen here in the United States, but independently, even if they don't see, I thought it ceased in
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Norway, knowing what's happening to the United States, how to approach it, it ceased, how is that the outcome, may actually inspire other people, because you do a fantastic technique of what I
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understand of the replacement of the orbit. Well, maybe that what you teach of all, how to replace and work the orbit, and you're working your lab, will be helpful For many other patients who
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lost their eye for other reasons, no? So it's not that the research will only affect I that it sees in a limited population in one single region of one country. The volume of information that you
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have will have a tremendous impact. So please, share with others.
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So the high dachits are all there. It can occur in the Western area. Mostly sister circuses rather than that it can occur because of granulosis. No, no, no. Go to Mexico. Yeah.
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I can't, yeah, yeah. Ali, I wonder if there are any residents or students or other people who'd like to ask questions? Yes, please, any question? Dr. Hyder is ready to answer
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that it's the disease is called cancer of Iraq at one time yes because so many people had high dietitist and if it ruptures, it goes into hundreds of daughtersists, they go to different organs. The
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only organ, only part of the body which could not be infected by by high dietitist is the tooth. It can affect any other part of the body. Mm-hmm. Yeah, and that's why, essentially, it's tricky.
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It's not just going to at the seast and let it leak. No, essentially it's tricky. Yeah. Yeah, absolutely You know, our teacher must have profiled. He tried to prove that the hydrated in the
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orbit is a sterile. And I follow him to prove this, but till now, we couldn't prove it. Although, when we remove the hydrated nautical and still now, not so strong evidence for the sterile
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system.
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Yeah, but I did a few Test on this. I had that fluid to hide that in the lab and there was no scolaces in those at all. Yes. Yeah. And the orbital hide I did. But no, we didn't publish such a
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research about the
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stability of that. Yeah. That's why my operation, which I did for and provides for hydrolysis, which
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I presented in Atlanta, Georgia in 2008. It was surgical approach, how to approach hydrolysis. You know that very well. Yes. That is based on the idea that hydrolysis of the orbit is not sterile.
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Is the sterile basically? Yes.
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Yeah. I don't want to take much time because the doctor hasn't also as well. I think,
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first I want to congratulate the doctor for holding this legacy about orbital surgery alive. I know it's not an easy job and I understand the situation that the hectic situation how can be difficult.
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I have two questions actually the first is that who you are as a center are you like how many neurosurgeon now and your center because during my training I didn't have the opportunity to attend any
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surgery or attend the training it's not obligatory during the board program so who you are how many neurosurgeon can do orbital surgery now independently and as there are as dent will be part of this
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center in the future and the next question what's the the vision your vision to the next five years and thank you thank you for your nice presentation thank you dr sammer thank you for your nice talk
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and in our center we have neurosurgeon we are a neurosurgeon about well but the real working with
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the orbit Dr. Ali shalci is with us today and Dr. Saad Farhan, Dr. Basim Syther, Dr. Haydakarm all of us we are five only working on the orbit. And the residents, we are training them. But
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once they get out, they may be missed them, a lot of information. So really, no one going in this field outside our center and working outside our center. This is about the first question. And
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for the next five years, I told you in future vision, we are planning to do a lot of orbitoscope It is our dream to introducing an award. And
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about this
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replacement, we are planning to do much more and to be more sophisticated. Thank you. Yeah, but I would suggest Dr. Heider in the coming five years, you try to establish some specialty of port
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in orbital surgery. I'm digging on this now Yes, it is good for you. Thank you. Any other questions, young guys, young friends?
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Yes. Please. Good evening. I'm Patima Akashowi, fourth year medical student University of Baghdad. It was really interesting in case it's And my best work was how to replace Misfar just by
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self-learning. It was real inspirational to me Thank you so much for having us. Thank you. Today's - there's nothing secret in the Google and the YouTube. Everything is clear and
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open for everyone. Just you have to have your won't do the such thing you are going to do. I encourage my technician to see the such videos. And sometimes we'll get help from other especially They
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are doing such a replacement, but not for the orbit, and we make connection with them, and we get this result that you saw before time. Thank you. Hi, Faris. Yes, doctor, I want to actually
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thank you, and encourage you because in Baghdad and Iraq, we don't actually have that many that this plastic or what you do, or do you call it? I want to ask you two questions. First, is your
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company or your job by your own payment, or does the government help you and financial you? And the second question, do you need volunteers from other medical schools from Iraq University,
24:13
succeeded to the third stage?
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Okay, thank you. We don't have any financial support from outside. We are working on our salary. And sometimes somebody offered to do our job in a private, in addition to the public, we refuse.
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Because we said always this patient have great disasters to lose their eyes. And we don't want to burden more on them and paying money So we refuse to do this replacement by any payment. And about
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one, that is where we welcome anyone. From third to fourth, to fifth, sixth, any time. Welcome. Thank you, Dr. Thank you. How do you - should we open the whole - just for discussion for any
25:09
speaker? What would you like to do? Well, do you want to open
25:16
Heidi to general questions
25:20
I'd like to ask Dr.
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Ali Salashi. We've heard some just outstanding presentations today of work all over Iraq. You have a difficult job trying to organize and put this all together and see if you can advance the
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healthcare in the country.
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What's your thoughts about how can we take advantage of all this talent and move forward? Yes, sir, I think now, as I said before, now we have facilities which we didn't have 10 years ago. So I
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think it's time to take further steps forward. Dr. Hader give a very important point before. We have to have a specialty board in orbit. And it's time, as I said, it's time for some specialities.
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And this is the time and the time that don't repeat itself always I think we have stuff that's very nice sigh curriculum in our medical college and this was the first step that integrate his system.
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And I think the second one is the team working now in the hospitals. Now there is no one, one man, one man, one man show, this has ended completely. And I think it's time also for the
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subspecialty and also for the post-graduate study to open post-specialty boards. So I think this is the time for us to work and to advance because if we don't take this chance, it may not repeat the
26:49
start again. Thank you.
26:52
We've heard some outstanding presentations from all over Iraq with very talented people. How can we, is there some way, and you do a lot of work which keeps you very busy day and night with 2, 000
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operations and a trauma center.
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How can we take advantage of all this talent in Iraq to move forward? We need more hospitals in Iraq. We have a lot of patience. hospitals. The same hospitals, 20th century, there's no more
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hospitals, the same neurosurgical hospital in Baribat and Kasmí and Shait Atman, no more new hospitals. We need more hospitals, to more students to be practiced. And the same like like in 20th
27:40
century, no more hospitals, no more beds, the same like before the war. We need more hospitals, more centers to be, to redo our bests.
27:55
Thank you for this nice wonderful zoom meeting. Thank you to show our teachers, learning
28:06
professors from Iraq, from inside and outside.
28:12
Thank you for this lectures, nice lecture for hysterical. How did you know? of neurosurgery, I
28:21
did my job in Amara City and may be I came late to this Zoom meeting. But may I
28:33
tell you about the first neurosurgeon, Sir Victor Horsley was in Amara and we should be a good neurosurgeon worldwide because we have a nice history. And as Victor and Marzia and Marzade, we need
28:36
to
28:53
build more hospitals, neurosurgery, specialty, our tertiary centers and more facilities. And we have many very good
29:05
neurosurgeon for doing more and more. Thank you again
29:10
Thank you, Victor Hader. Thanks for reminding us with the Victor Horsley and Marzia. Have you seen his tomb?
29:18
Symmetry? Yes, I saw Symmetry and Amara and I wrote on his history and neurosurgery published
29:31
High Scored Magazine, a historical magazine from England. I share my paper with them and pictures new and all pictures and of course of his history in neurosurgery who is the first pioneer of
29:47
neurosurgery As you know and you'll learn us. Thank you. Excellent, excellent. Good. Anap, Osama is raising the hand also. Osama, please.
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Hello everyone. I'm Anap Osama, medical student in the entire stage at the University of Ghana. Actually, I don't have a question. I want to say To make us involve here, it's great to create new
30:14
surgeons at all.
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Thanks for Dr. Samerhose and Dr. Hadif Ali with the
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SNR team to be here. And actually, me as a medical student at University of Baghdad and interested in neurosurgery, I want to say thanks a lot to Dr. Adi Shachi and Dr. Haidav and how many to
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make me look at me in support because I spent my summer holiday and now in the positive heavy teaching hospital and I see a effect case and I learned more and more about the
30:46
neurosurgery field So thanks so much.
30:49
Thank you so much. Thank you.
30:54
Um,
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yeah, we try to get has that on the phone. I think we can conclude now. Maybe it's too late. There's a connection issue. Yeah. I think Dr. Elle. It's already midnight. Yeah, Dr. Ali. Just
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Dr Ali have a question Hi, Hardy.
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Yeah, thank you very much. It's not a question. Just a comment. You know, when we have started our greatest system, one of the important things that the students are in our ability to do their
31:26
work or to to interfere with our work, you see, one of them is Anna who's always coming to our theater and watch their surgery. In the summer holiday, I have signed about 150 requests from the
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students to go to the hospital to know how to use injection and how to use suturing wounds in the casual tune. These things are now very popular with the students. So students now are volunteers and
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asking to interfere with work without asking them or obliging them to be part of it. You must come to space if you don't come there, then you will be punished notes. That's the other thing around.
32:05
Now the students are volunteer. They like to put themselves in the work each day. Thank you very much. Thank you very much for our speakers. or Dr. Osman, Dr. Lazare, the summer, thank you so
32:20
much, and for all the attendees. And what we hope really from this last session of inviting the
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leaders of neurosurgery in Iraq, we hope that our young neurosurgeons, students of the board, young graduates, to join
32:43
the SI in future meetings and to benefit from their experience and their ideas and also to benefit from the experience of the senior neurosurgeons in this group and beyond. So we'd like our leaders
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to encourage their students, their new graduates to join and
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they are welcome to be part of SI back then.
33:13
And thank you so much, Dr. Jim. Do you have any comment? I think, Madi, you and I would like to thank Sammer, who has put in a huge effort to organize these meetings. And he's a young force in
33:33
Iraq. And I think he's done a terrific job of not only trying to stimulate older neurosurgeons, but the young students and their interests And
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I'd push them on a congratulate.
33:48
I would like to say, I'm sorry, I'll take a minute, something for the students, the majority of the audience are the students. And the students who are in SNI-15, wearing SNI-14, and will be in
34:00
SNI-18. So for you, yes, when you train us as a surgeon, you want to do it. Can I do it? Can I do it? Can I touch it? Can I do it? Can I switch on? can remove weird. actively looking to do
34:15
something. But sometimes there is enormous wealth in the chance of looking. So you just look how the pay pay attention to the patient, to the disease, how the professor approach. Write a note.
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Your best friend, if possible, if the patient and the professor allows is the camera in your cell phone. Take a picture of her thing. Take a picture of that MRI Raise the name of the patient.
34:45
There are many things to be learned besides the actual incision, drilling, removing, microscope on, take it out, no? And you have what I've seen today, enormous amount of clinical wealth in
35:01
your hospital. They are concentrated. You have a hospital with 1, 000 or 2, 000 surgical procedures. So that is 2, 000 opportunities to learn something not from the disease, but from the
35:14
patient who suffers data disease. Yes, we want to be surgeon, we want to do, we want to do the surgery, we want to put the microstalk, we want to command the room, but often until we reach at
35:28
that time, don't
35:31
lose the opportunity of paying attention to the details, how that the professor holds the, forceps, when they do, when they stop, how much tumor they leave behind, why they didn't take it out?
35:48
All those, all those things are part of the teaching, and you have an enormous wealth. Medical students in Iraq, you are blessed by having enormous number of cases concentrated in few hospitals
36:05
and with wonderful teachers as you have seen today I'm not talking anymore, don't worry, thank you.
36:15
Yeah, I would say just at the end, I'm really proud of this moment. I think that's part of my duty that to whenever possible to bring our teacher, like Dr. Anur, Dr. Ahmed, Dr. Ali, and Dr.
36:31
Heder made today, those are our teachers, those who bring neurosurgery to us, and whenever there is a possibility and having them
36:45
on this stage presenting their work, it's the maximum moment of proudness for us. And yeah, we are standing on the shoulder of giant. This is, I think for me, it's a culture I want to bring it
36:59
more and more for people in Iraq, especially for the end generation. And yeah, we are nothing without our teacher and we are shamefully advanced, shamefully, behind them. if we do not advance
37:14
beyond them. So whenever we are doing a new procedure, we are doing advancement. Yeah, okay, the importance come back to the teachers, come back to our professor. So thank you for all of them.
37:28
And for me, I'm really proud to have them here. Thank you. Thank you. I think there's one, there's a question or any other comment from Dr. Oh, we just lost it. Okay Yes, the gentleman. Oh,
37:42
Dr. Oh, yeah. Yes. The panel, please. Sir, I'm Arikum. Thank you. I am Dixar Ahmed. Second was graduated from the Iraqi city, from
38:10
the last year, I am under teaching, under the professor at the church, and a professor at the primary. Thank you, our teacher and our colleagues for this meeting I just noticed about the Addazi
38:12
Hariri Hospital. Under
38:15
the teacher of the professor, Al Sharchi and Haidar Jaimei, we have a lot of spine surgery, advanced spine surgery, and for fixation, our ACDF, our T-lift, T-lift, and a lot of cases daily.
38:31
Daily, there is an orbit on the brain tumors and the spine, about five to seven to
38:41
10s, day, day surgery, doing the Raziel Hariri. We thank, we grant for thanks for our teachers, Victoria Arishach, and Victoria Hariri
38:51
for teaching us, and a broad of you, and push us for the
38:59
front refuge. Thank you very much. Very good, thank you, thank you so much. Thank you Just one last point to mention that in the future meeting,
39:12
We are planning to have one topic to be a target and then part of the session will be general topics. So one topic will be like oncology, neuro oncology or maybe pediatrics surgery or maybe acoustic
39:29
neuroma or whatever. So one topic it will be a target in the future meetings as part, main major part of the meeting and then the other part of the meeting would be generally presentations. So that
39:42
would be possibly tempting to all our colleagues to listen to a topic which tickles their interest. Okay.
39:51
Yeah. Wonderful. Thank you so much. Thank you. Thank you. Thank you very much. Thank you very much. Thank you very much. Bye bye. Bye bye. Bye bye. Bye bye. Thank you very much, sirs.
39:53
Bye bye, bye, bye, bye. Thank you.
40:08
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