DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right carotid-ophthalmic aneurysm.
POSTOPERATIVE DIAGNOSIS: Right carotid-ophthalmic aneurysm.
OPERATIONS PERFORMED:
1. Right frontotemporal craniotomy.
2. Extradural partial clinoidectomy and clipping of the aneurysm.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
COMPLICATIONS: No complications.
SPECIMENS: No specimens.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old lady who presented to the office with two aneurysms, one located in the right carotid-ophthalmic segment, one measuring between 9 and 10 mm, and the other one in the left MCA, measuring approximately 7 mm. We discussed the natural history of the aneurysm, particularly unruptured, and also discussed the treatment options. The aneurysm which is the largest, in the right carotid-ophthalmic segment, is ventrally pointed, has a very large base, and coiling will not be indicated, and the only other way is just to have a stent and also coil after stents. Because of this, the patient preferred to have surgical clipping. The patient understood the risks and benefits of the procedure, in particular the risks which mainly consisted of hematoma, reoperation, infection, stroke, paralysis, and signed the consent.
DESCRIPTION OF OPERATION: The patient was intubated and placed in a supine position with the head tilted to the left. A frontotemporal craniotomy flap was marked, prepped, in a hair-sparing technique. The incision was made with a 10 blade scalpel with Bovie coagulators, and the scalp and temporalis muscles were reflected anteriorly and inferiorly. Then, the Midas Rex was used to shave a frontotemporal craniotomy flap. The sphenoid wing was drilled off and partially also the clinoid was drilled extradurally.
Under the microscope with microdissection illumination, the dura was opened in a C-shaped fashion and then the body of the retractor was used to retract the frontal and temporal lobe. The annulus was immediately found, and there was no need to have more drilling of the anterior clinoid. The aneurysm was resected and clipped with a right angle fenestrated clip. Then, the area was inspected and flow was found to be normal in the carotid artery, and the aneurysm was completely obliterated.
The dura was then closed with 4-0 Vicryl. The bone flap was replaced and affixed with miniplates, but before that, the dura was tacked up to the edges of the skull. Subsequently, the muscle was closed with 2-0 Vicryl. Subcutaneous tissue was closed with 3-0 Vicryl and the skin closed with staples. A Jackson-Pratt was left in the subgaleal space.
