DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left posterior fossa mass.
POSTOPERATIVE DIAGNOSIS: Left posterior fossa mass.
OPERATION PERFORMED: Left level II lymphadenectomy with identification of neurovascular structures.
SURGEON: John Doe, MD
CO-SURGEON: Jane Doe, MD
ANESTHESIA: General endotracheal.
ESTIMATED BLOOD LOSS: Less than 10 mL.
SPECIMEN: Left level II lymph nodes.
DESCRIPTION OF OPERATION: The key points of this case and resection of tumor will be performed by the co-surgeon. I was asked to expose the neurovascular structures of the neck and perform a level II lymph node dissection. After the patient was under general anesthesia with endotracheal tube, the neck was prepped and draped in sterile fashion.
An incision was carried down from inferior and posterior to the mastoid tip down over the sternocleidomastoid muscle and through a neck crease in the mid half of the neck. The incision was carried down deep through the platysma muscles. A subplatysmal plane was elevated superiorly up to the angle of the mandible and to the mastoid tip. The sternocleidomastoid muscle was identified, and the dissection plane was carried along the sternocleidomastoid muscle anteriorly for identification of the eleventh cranial nerve. This was identified and skeletonized up to the level of the jugular vein. The fibrofatty lymph tissue in the neck was then dissected free from inferior to the digastric muscle inferiorly along the floor of the neck, the jugular vein and carotid artery down to the level of the cricoid cartilage. This was then removed and sent for permanent pathology.
The jugular vein was skeletonized superiorly up to the level of the mandible. A vascular loop was placed around the jugular vein for identification purposes. The carotid artery was identified. The internal carotid artery was identified and skeletonized superiorly. A vascular loop was placed around the internal carotid artery for vascular control. The vagus nerve was identified and preserved. The hypoglossal nerve was identified and preserved. The tissues were dissected free from the digastric muscle posteriorly up to the mastoid tip. The facial nerve was identified just superior to the attachment of the posterior digastric muscle. Hemostasis was obtained with bipolar cautery. The wound was thoroughly irrigated. At that point, the procedure was handed over to Neurology and Neurosurgical Services.
