DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right clinoidal meningioma.
POSTOPERATIVE DIAGNOSIS: Right clinoidal meningioma.
OPERATION PERFORMED:
1. Orbital frontal approach with complete anterior clinoidectomy.
2. Gross total resection of clinoidal meningioma.
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 woman who presented to the emergency room with grand mal seizure. Imaging workup of the brain showed evidence of an enhancing mass stemming from the anterior clinoid process consistent with a clinoidal meningioma. There was significant amount of brain shift and surrounding brain edema, and therefore, it was recommended that the tumor be removed as the best means of treatment.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed under general anesthesia. She was then placed supine on the operating room table. Mayfield headrest was applied to the skull, and she was positioned in preparation for a pterional-type orbital frontal craniotomy. The neck was maintained in neutral position so that the jugular veins would drain freely. The right frontotemporal area was then prepped and draped in the usual sterile fashion.
Using a #15 blade knife, the skin was incised along the course of the planned pterional-type craniotomy. The scalp was reflected inferiorly and held in place with suture. The temporalis muscle was incised leaving a mild fascial cuff for later reattachment and also retracted inferiorly.
A Midas Rex drill was then used to create entry bur holes at the orbital frontal angle and in the temporal area. The Midas Rex drill was then used to create an orbital frontal-type craniotomy taking with the pterional bone flap of the orbital roof. This was a one piece-type orbital frontal craniotomy. Small tear in the orbital periosteum was repaired with 4-0 Nurolon suture.
Temporal and frontal lobe retractors were then placed and extradural complete anterior clinoidectomy was performed using microsurgical technique and the operating room microscope. An AMA drill bit was used to microsurgically bur down the hypertrophic anterior clinoid after releasing from surrounding tumor-involved dura. Once the anterior clinoid was removed and the tumor undermined and released from the bony attachment, the dura was opened in a curvilinear fashion and retracted anteriorly.
Frontal and temporal retractors were again placed carefully on the brain underneath. The basal cistern was opened to allow CSF to drain and relax the brain. The tumor was then circumscribed first releasing it from the sterile attachment and devascularizing it completely. The dural base of the tumor was also excised. Bipolar cautery and gentle blunt dissection was used to develop the arachnoid and peel plain between the tumor dome and the surrounding brain tissue.
The tumor was circumscribed completely and removed in nonblocked fashion achieving a gross total resection. Hemostasis was obtained with bipolar cautery. The wound was irrigated with warm saline solution to confirm hemostasis. The dura was then reapproximated using interrupted 4-0 Nurolon sutures. Central dural tack-up suture was placed and the bone was secured with Synthes titanium plates and mini screws.
A subgaleal JP drain was placed, and the galea was reapproximated using interrupted 0 Vicryl sutures. Staples were then placed to reapproximate the skin edges. Sterile dressing was placed. The patient was extubated in the operating room and transferred to the recovery room in stable condition. There were no complications.
It should be noted that a small separate permanent section was sent from the dura along its incision line. A small mass was found here and had the appearance of a separate small meningioma measuring less than 4 mm in diameter. The specimen was labeled superficial tumor.
