DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Frontal meningioma.
POSTOPERATIVE DIAGNOSIS: Frontal meningioma.
OPERATION PERFORMED: Bifrontal craniotomy and removal of meningioma.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
COMPLICATIONS: None.
SPECIMEN: Meningioma.
INDICATION FOR OPERATION: The patient is a (XX)-year-old gentleman who has a history of progressive decline of his mental status and his function in general, including walking ability. He was found to have a very large frontal meningioma extending from the midline incorporating the superior sagittal sinus and also eroding the skull. The meningioma was also extending from right to left. After discussion with the patient and the family, the decision was made to proceed with removal of the brain tumor. The patient understands the risks and benefits of the procedure, in particular the risks which mainly consisted of seizures, hematoma, re-operation, infection, brain swelling, increased intracranial pressure after surgery, and death.
DESCRIPTION OF OPERATION: The patient was intubated and placed in a Mayfield headrest. A bifrontal craniotomy was marked and was draped in sterile fashion. The incision was infiltrated with lidocaine and epinephrine. The periosteum was dissected and the bone was found to be infiltrated by the brain tumor. A large craniotomy was performed, and the central part of the skull was removed because of tumor infiltration. Then, the dura was cut all the way around the tumor, and the tumor was progressively dissected off the brain. Anteriorly and posteriorly, the sinus was coagulated, ligated, and the falx was progressively coagulated and cut and the tumor was decreased in size by using Bovie loops and suction.
At the end, the entire tumor mass was removed, and hemostasis was maintained. The lesion was sent to pathology, which confirmed the preoperative diagnosis of meningioma. Then, a large piece of dura substitute was used to patch the large dural defect. This was sutured inside with 4-0 Vicryl. The area was then irrigated with antibiotic solution. The bone flap was replaced and the bony defect was then covered with a dual titanium mesh and also methacrylate. The area was again irrigated with antibiotic solution and then the incision was closed with 2-0 Vicryl and staples. Two Jackson-Pratts were left in the subgaleal space.
