DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left cerebellar brain tumor.
POSTOPERATIVE DIAGNOSIS: Left cerebellar brain tumor.
OPERATIONS PERFORMED:
1. Posterior fossa craniotomy.
2. Gross total excision of metastatic cerebellar brain tumor.
3. Microdissection using operating room microscope.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old man who complained of gradually increasing lethargy and unsteadiness on his feet. He came to the emergency room and had a CT scan of his brain performed. This showed evidence of a large 4.5 cm mass occupying most of the left cerebellar hemisphere and causing occlusion of the fourth ventricular pathway. Because of the occlusion of the fourth ventricular pathway and evidence of early hydrocephalus on the scan, it was recommended that he be taken to the operating room on an emergent basis for evacuation of the mass. A chest x-ray showed a large middle lobe mass measuring 9.5 cm in diameter consistent with a lung primary. It was suspected that the left cerebellar mass represented a metastatic deposit from his lung tumor.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed under general anesthesia. He was then placed in a Mayfield headrest and positioned prone on gel rolls. His neck was maintained in gentle flexion in a neutral rotation. The posterior cervical area was then prepped and draped in the usual sterile fashion.
Using a #15 blade knife, the skin was incised in the midline, and monopolar cautery was used to dissect through the subcutaneous tissue to open the fascia and reflect the paraspinal muscles and occipital galea laterally exposing the occipital bone and the C1 and C2 vertebrae. In order to gain access to the foramen magnum and low cerebellar area, a decompressive C1 and C2 laminectomy was performed. This provided a better view to the patient’s steep occipital bone. A Leksell rongeur was used to perform the bilateral laminectomy of C1 and C2. The Midas Rex drill was then used to create entry bur holes on either side of the midline of the occipital bone just below the transverse sinus. The Midas Rex drill was then used to turn an occipital flap crossing the midline and centered more to the left than the right. The flap was removed exposing the underlying dura. The dura was opened in a curvilinear fashion exposing the left cerebellar hemisphere and the foramen magnum. CSF was withdrawn decompressing the posterior fossa.
Corticectomy was then performed exposing the tumor. The operating room microscope was brought into the field and used to assist with performing a microsurgical removal of the tumor. Bipolar cautery was used to develop a plane between the tumor and the surrounding normal cerebellar tissue. Hemostasis was obtained using the same technique. Excellent resection was achieved. Specimen was sent for permanent section. The tumor was soft and friable.
Following gross total resection and establishment of hemostasis, the dura was then reapproximated using interrupted 4-0 Nurolon sutures. The repair was reinforced with 5 mL of Tisseel. Gelfoam was then placed over the repair. The bone flap was replaced and screwed and secured with Synthes miniplates and screws. The wound was then irrigated with antibiotic solution and closed in the usual fashion using interrupted 0 Vicryl sutures on the fascia and interrupted 2-0 sutures on the subcuticular layer followed by staples on the skin. A sterile dry gauze dressing was then applied. The patient was extubated in the operating room and transferred to the recovery room in stable condition. There were no complications.
