DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left Meniere’s disease.
POSTOPERATIVE DIAGNOSIS: Left Meniere’s disease.
OPERATION PERFORMED: Left endolymphatic sac decompression and pressure equalizer tube insertion.
SURGEON: John Doe, MD
ASSISTANT: None.
COMPLICATIONS: None.
INDICATIONS FOR OPERATION: This is a (XX)-year-old gentleman who has classic Meniere’s disease with fluctuating hearing loss, principally low frequency, episodic vertigo, fullness and tinnitus, which he has had for approximately eight years but has gotten increasingly frequent vertiginous episodes, more violent and lasting longer. This is despite maximum medical treatment. An endolymphatic sac decompression was offered, and the risks and benefits of this were explained.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed in the supine position. After induction of general endotracheal anesthesia, the bed was rotated 90 degrees. The patient was prepped and draped in the usual fashion.
A postauricular incision, approximately 1 cm posterior to the postauricular crease, was performed and extended to the subcutaneous tissue exposing the musculoperiosteal layer. The musculoperiosteal layer was incised with a Bovie in a T-shape fashion. A periosteal elevator was used to expose the entire mastoid cortex. The spine of Henle was identified. A cortical mastoidectomy was performed using a 6 mm cutting bur. We had a rather well pneumatized mastoid with an anteriorly placed sigmoid. The sigmoid was identified. The antrum was entered. The posterior canal wall was thinned down to identify the facial nerve. The lateral canal was identified as was the posterior canal. Some retrofacial air cells were opened and the tegmen identified. A diamond stone was then used to skeletonize the sigmoid sinus in the region of the hard angle. The dura overlying the endolymphatic sac was then removed with the diamond stone, and he had a rather prominent endolymphatic sac.
With the sac decompressed, the wound was copiously irrigated. The musculoperiosteal layer was approximated with 3-0 Vicryl, and the postauricular incision closed with 3-0 Vicryl and Dermabond. The PE tube was then placed. A mastoid dressing was placed. The patient was awoken from general anesthesia and transferred to the recovery room having tolerated the procedure well.
