DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right frontal brain tumor.
POSTOPERATIVE DIAGNOSIS: Right frontal brain tumor.
OPERATION PERFORMED: Right frontoparietal craniotomy with image-guidance system and removal of the tumor.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
COMPLICATIONS: None.
SPECIMEN: Brain tumor.
INDICATION FOR OPERATION: The patient is a (XX)-year-old gentleman who was sent into the emergency room with new-onset seizures. In the ER, we evaluated with CT scan and MRI, which showed the presence of a right frontal lesion consistent with brain tumor. After evaluation and discussion with the family and the patient, we decided to schedule surgery, which will consist of removal of the brain tumor. Prior to surgery, the patient had an MRI scan, BrainLab image-guidance system. The patient and the family understood the situation and understood the findings and the risks and benefits of the procedure. In particular, the risk of surgery is mainly, but not exclusively, stroke, hematoma, reoperation, infection, seizures, CSF leak, meningitis or paralysis. The patient did understand all the risks, the family understood the risks, questions were also answered, and the patient finally consented.
DESCRIPTION OF OPERATION: The patient was intubated and placed in the supine position with the head in the Mayfield head holder. The image-guidance system was brought to the OR, and the patient’s head was registered to the BrainLab system. After that, the ideal craniotomy area was mapped on the scalp and localization of the tumor was then completed.
A linear incision was then marked on the scalp. It was prepped and draped in the usual sterile fashion. An incision was made with a 10 blade scalpel, and Bovie coagulator and the scalp was reflected anteriorly and inferiorly. Then, with the use of Midas-Rex, a craniotomy was performed anterior to the coronal suture, approximately 4 cm, and stenting posteriorly to the coronal sutures approximately 3 cm. This allowed us to completely control the entire tumor mass. After that, the craniotomy was performed and mid dura was opened with the base to the superior sagittal sinus. By using the image guidance, the tumor margins were mapped on the brain and then the resection was started by opening the arachnoid on the surface in the way to completely outline the superficial part of the tumor. Then, the resection was gradually completed by debriding all the directions with the help of the image guidance to make sure that we were all the way around the tumor. The biopsy was sent to pathology and the answer is that this is brain tumor, but the type is still not clear at the frozen section.
Hemostasis was accomplished. The dura was closed with 4-0 Nurolon in a watertight fashion. DuraGen was applied over the dura, the bone flap was replaced and secured with miniplate, and the Jackson-Pratt was left in the subgaleal space. The scalp was closed with 2-0 Vicryl and staples for the skin.
