2012-03-24 Operative Procedure Report

DATE OF SURGERY: 03/23/2012

PREOPERATIVE DIAGNOSES:
1. Left frontal tumor.

POSTOPERATIVE DIAGNOSES:
1. Left frontal tumor.

PROCEDURE PERFORMED:
1. Left frontal craniotomy with gross total excision of high-grade glioma.
2. Use of Stealth stereotactic system for intradural navigation.
3. Use of operating microscope.

SURGEON: Smith, MD

ANESTHESIA: General endotracheal anesthesia.

FINDINGS: There was an intrinsic high-grade tumor with gross total resection performed.

DETAILS OF PROCEDURE: The patient was brought to the operative suite. After satisfactory general endotracheal anesthesia, he was placed in 3-pin Mayfield head holder, placed in supine position, neck slightly flexed. He was registered to the Stealth stereotactic system, and the tmnor borders were delineated. A curvilinear incision was strip shaved, prepped and draped in the usual sterile fashion. This incision was then opened. Raney clips were applied. The tumor borders were then marked again on the cranium.  Bur holes were placed which were connected with a craniotome.  The dura was opened laterally and flapped medially. An intrinsic tumor was immediately visible upon opening the dura.

The microscope was brought into the field.  Stealth used to delineate anatomically the extent of the tumor and this matched with the findings noted with visualization through the microscope. Using bipolar cautery and microdissection techniques, pia was coagulated and divided. The tumor was entered. Several specimens were taken, and using suction and coagulation, the borders of the tumor were sought anteriorly, posteriorly and laterally and then medially against the falx . Resection of all the _____ of the tumor assisted in hemostasis and once all the tumor had been resected, hemostasis was relatively easily obtained.

The dura was repaired with 4-0 dural sutures and bolstered with Duragen. The bone flap was replaced with a Lorenz plating system. The wound was closed in layers with Vicryl and staples. At the termination of the procedure, all sponge and needle counts were correct. The patient tolerated the procedure well, was transported back to the recovery room in stable condition.

 

 

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