Muhamed A Fayed, MD. @MFayed_MD
Neurosurgeon 🧠🇪🇬 @SGHC 🦋 Soul Dancer🕺🏻 Cairo, Egypt Joined February 2014-
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Medullary cavernomas are the least common of the brainstem cavernomas. Going into the medulla is daunting, but when a patient presents with “crescendo” bleeds – multiple over a short time – going in to remove the pathology is the right thing to do…
Midbrain cavernomas that surface below trochlear nerve, low in cerebellomesencephalic fissure, are special. Instead of a supracerebellar approach, an occipital-transtentorial approach may be preferred, especially when you can’t use gravity retraction. Trochlear nerve leads you…
Brainstem taxonomy classifies cavernomas into unique subtypes, but large ones can combine 2 subtypes, like this tegmental-interpeduncular midbrain cavernoma. Lateral SCIT’s surgical corridor thru midbrain gives a wild view into interpeduncular fossa from behind basilar…
In this operative video, Dr. Cohen describes the techniques for clip ligation of MCA aneurysms, and more specifically the strategies for bilobed aneurysms. This is a 63-year-old female with an unruptured MCA aneurysm. To watch more of this video, sign in with your Neurosurgical…
Cavernomas look like mulberries embedded in pudding, their compartments of liquified blood sparkling like a jewel under the glare of the microscope’s light. So satisfying the way that the combination of traction, cautery, and sharp dissection peel then away from gliotic brain…
Pure white tumor contrasts so sharply w/brain’s natural colors that it makes epidermoid tumors a beautiful spectacle. Normally resected thru cerebellopontine angle, I chose a transsylvian route for this high-riding tumor, which helped work it free from carotid & basilar…
One craniotomy (extended retrosigmoid), 3 cavernomas removed (1 petrosal cerebellar, 2 middle peduncular pontine), 7 cranial nerves in view (CN V – XI). This case shows why the extended retrosigmoid approach is the workhorse for cavernomas in the posterior fossa, deep and…
“Giant” means something different w/ every pathology. For aneurysms, it’s diameter >2.5cm. With cavernomas, we proposed diameter >3.0cm. Here’s one in the insula/putamen that comes out nicely thru sylvian fissure between branches of M2 MCA. Beware ascending lenticulostriate…
Although small and superficial, this arteriovenous malformation requires so many delicate moves & steps to circumferentially dissect the pathology & remove it from adjacent brain. The vein is like an odometer on your surgical journey, changing from an angry red to mellow blue…
Do you know the cerebellum’s tonsillobiventral fissure, aka “secondary fissure?” PICA's cortical branches lead you in, as do intersecting folia, and it provides a route over the tonsil to reach below and lateral to dentate nucleus, shortening the path to the target thru tissue…
Clipping a left-sided MCA aneurysm from the right is bold surgery & long reach. But 7% of pts w/MCA aneurysms have bilateral MCA aneurysms & clipping both thru 1 craniotomy spares 2nd craniotomy. Contralateral clipping is possible with aneurysms projecting anterior & inferior,…
For the vascular neurosurgeon, choroidal fissure is like a Sylvian fissure hidden inside the brain. Meticulous dissection along fornix enlarges foramen of Monro, unroofs 3rd ventricle, and w/gravity retraction + contralaterality, takes you to medial thalamus. But beware the upper…
Some aneurysms are good at hiding, like the posteriorly projecting ACoA aneurysm, even more so when high-riding. Success comes from knowing where to look for hidden aneurysms, & here it’s the junctional triangle – that potential space between A1 and A2 segments & gyrus rectus...
Many moyamoya patients are treated w/ synangiosis procedures or onlay grafts, which makes them difficult to treat if they need even more blood flow. Usually, another donor artery (other STA,OA) can be found & direct bypass w/ surgical anastomosis will bring the flow they need…
To mark Brain Aneurysm Month, here’s a simple but high-riding ACoA aneurysm. It’s important to see 12 arteries around ACoA complex before clipping: big 5 (bilateral A1 & A2 segments plus ACoA), 6 branches (bilateral recurrent arteries of Heubner, orbitofrontals, frontopolars),…
Cavernomas are hunted like a bloodhound and I study MR images beforehand to anticipate where target pathology might hide. In this case, half of this medullary cavernoma was bulging into 4thventricle but the other half has hiding inferolaterally in cuneate nucleus. Enjoy the…
How do you expose ventral foramen magnum meningiomas extending to both sides? Unilateral far lateral craniotomy gets the job done. De-arterialize, debulk, then dissect it from cranial nerves, brainstem, vertebral arteries. The key: preserve delicate anterior spinal arteries…
Critical anatomy in the carotid cistern – optic & oculomotor nerves, carotid artery, choroidal and posterior communicating arteries, even posterior cerebral artery – can make cavernomas in the medial temporal lobe/uncus risky. But resection brings seizure freedom……
كلام سمعناه و بنسمعه و هنسمعه ... فلنعمل أكثر و نتجنب الأحكام قدر المستطاع
كلام سمعناه و بنسمعه و هنسمعه ... فلنعمل أكثر و نتجنب الأحكام قدر المستطاع

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