Ilyas Munshi, MD

29/05/2025

Case Presentation of the Week: 48 yo female who presented to our office complaining of posterior cervical pain radiating into the left upper extremity. She had associated weakness of the left upper extremity as well. She had tried medications, physical therapy, and injections with no relief of her pain. MRI of the cervical spine revealed herniated nucleus pulposus at C4/5, C5/6, and C6/7. You can view the pre-op MRI image below. She underwent an Anterior Cervical Decompression and Fusion (ACDF) which involves cleaning out each disc space and replacing the disc with a new Interbody. The Interbody allowed the spine to maintain its height, but this takes the pressure off the spine. The Interbodies were secured with an anterior plate and screws. You can see the hardware in the post-op X-rays below! The patient did very well post-operatively and was discharged home. At her post-op appointment, she reported significant improvement in her pain. At her 3 month follow-up appointment, she reported resolution of her posterior cervical pain and left upper extremity pain. Her weakness had also improved significantly.

25/05/2025

In Portugal

21/02/2025

A 72-year-old male Dr. Munshi was consulted to evaluate for frequent falls and altered mental status. The patient had been experiencing a shuffling gait resulting in multiple falls and injuries. He had been admitted to rehab facilities for extensive physical therapy without any improvement in his ambulation. He was also noted to have worsening confusion and functional decline. He underwent a CT of the head, which demonstrated ventriculomegaly or dilated lateral ventricle. His evaluation also involved a lumbar puncture that showed normal opening pressures, measuring the pressure within the spinal cord. He underwent an MRI of the brain which demonstrated dilated lateral ventricles, a dilated third ventricle, with narrowing of the aqueduct of Sylvius, or the channel between the third and fourth ventricle. Dr. Munshi evaluated the patient and imaging, discussed the findings with the patient and family, and it was decided to proceed with a third ventriculostomy.

The patient tolerated the third ventriculostomy well, saw significant improvement in his gait and cognitive function, and did not require the placement of a permanent CSF diverting device.

Third ventriculostomy is a surgical procedure to create a bypass for cerebrospinal fluid to flow in the brain. It is done by introducing an endoscope, a thin tube with a camera, and light device, to allow visualization within the third ventricle. An opening is then made in the floor of the third ventricle to allow CSF to flow through into the subarachnoid space, where it then can be absorbed into the bloodstream. The benefit of this procedure is it allows minimally invasive techniques to allow a diversion of CSF through the brain to treat dilation of the ventricle without placing a permanent device, such as a ventriculoperitoneal shunt.

19/12/2024

Happy Holidays from our office to you!

31/10/2024

🔪 Hope you have a killer Halloween from Dr. Munshi & Staff 🎃

Ilyas Munshi, MD APMC is a Board-Certified Neurosurgeon who has practiced Neurological Surgery in th

17/09/2024

A 77-year-old male who Dr. Munshi was consulted to see for evaluation of increasing difficulty walking, worsening lower back pain, and lower extremity weakness that had been gradually deteriorating over the few months prior. He had multiple falls in the months prior secondary to his symptoms. He underwent imaging of the spine demonstrating a large intradural, extramedullary mass with a hemorrhagic or cystic component. Dr. Munshi evaluated the patient and imaging showed the intradural tumor. After reviewing imaging with the patient and family it was decided to proceed with surgical intervention to remove the spinal cord lesion.

The patient underwent T11-L2 laminectomy, durotomy, and resection of the intradural tumor. This procedure first entailed performing a laminectomy, which involves the removal of the spinous process and the lamina bilaterally to expose the thecal sac, the membrane surrounding the spinal cord. The thecal sac was then opened to reveal the spinal cord, nerve roots, and the lesion. The lesion was then carefully removed using microscopic dissection. Once the lesion was removed, the dura was closed using a suture. Pathology testing of intra-operative samples revealed the lesion to be a schwannoma, which is a usually benign nerve sheath tumor originating from the Schwann cells that insulate and protect nerve cells.

The patient progressed very well following surgery. He experienced post-op lumbar soreness but saw significant improvement in his lower extremity weakness and improvement in his gait. He was no longer requiring a walker to ambulate. Post-operative imaging demonstrated good removal of the tumor.

03/07/2024

This is a 67-year-old male whom Dr. Munshi was consulted to see in the hospital. He presented to the emergency department for evaluation of confusion which had been worsening over the past one and a half months with associated unsteady gait, weakness, and multiple falls. He underwent imaging demonstrating right parietal and left frontal lobe lesions with large amounts of surrounding edema and leftward midline shift. Dr. Munshi evaluated the patient and recommended he undergo bilateral craniotomy for abscess resection.

The patient underwent right parietal and left frontal craniotomy, which involves removing a part of the skull to visualize the brain. Image-guided navigation was then used to pinpoint the exact locations of the masses. Dr. Munshi then used fine microscopic dissection to remove the intact encapsulated abscesses while leaving normal brain tissue intact. Once the abscesses were successfully removed, the skull bone flaps were replaced and the surgical site was closed.

The patient progressed well postoperatively and experienced significant improvement in his confusion, unsteady gait, and weakness.

08/03/2024

The patient is a 50-year-old female whom Dr. Munshi was consulted to see in the hospital. She had been experiencing weakness that worsened that morning, as well as near syncopal episodes, bilateral blurred vision, fatigue, and confusion for a few weeks prior. Imaging was obtained demonstrating a 4.5 cm x 6.4 cm x 6.1 cm frontal lesion causing displacement of the frontal cerebral hemisphere and adjacent vascular components with 2.5 cm of rightward midline shift. She was recommended to proceed with surgery and underwent left frontal craniotomy for tumor resection. The intraoperative pathology demonstrated findings consistent with meningioma. The patient required intensive rehabilitation postoperatively. She progressed well over time, experiencing improvement in her preoperative deficits and a return to the baseline of her personality, which had been altered secondary to the compression of the area of the brain controlling personality, emotions, and decision-making.

Meningiomas are the most frequent primary brain tumors and are mostly benign. The majority of meningiomas are found incidentally in imaging studies and cause little to no symptoms. When present, the most common symptoms are seizures, visual changes, hearing or smell loss, mental status changes, or weakness, depending on the location of the meningioma. They are diagnosed on both MRI and CT, with MRI being the imaging of choice. Many meningiomas are managed with conservative therapies and monitoring, and only require removal once they become symptomatic, compress vital structures, or significantly change in size.

19/02/2024

As part of his practice. Dr. Ilyas Munshi uses minimally invasive surgical techniques to treat his patients.

One of these minimally invasive spinal surgery techniques is a microdiscectomy to remove impingement on the spinal cord and nerve roots. It is a procedure performed by making a small incision over the surgical site, significantly smaller than traditional open procedures. Through the small incision, a progression of dilators are inserted to create a tunnel leading to the vertebrae overlying the nerve root and disc. A microscope is then utilized to visualize within the dilators. The bone overlying the compressed spinal nerve is then removed to uncover the nerve. The spinal nerve is then gently retracted to visualize the herniated or damaged disc on the other side. The damaged disc fragments or bone overgrowth is then removed to decompress the nerve. Through the already made incision, vertebral interbody instrumentation can be placed or posterior lateral pedicle instrumentation can be placed, if deemed necessary.

There are multiple benefits of minimally invasive spinal surgery. Many patients experience less discomfort secondary to skin incision and muscle manipulation, go home the same day, or have shorter hospital stays, less risk of postoperative infection, and faster recovery with less rehabilitation needed.

23/12/2023

The back bowls in Vail.

19/12/2023