DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left frontal calvarial-based mass.
POSTOPERATIVE DIAGNOSIS: Left frontal calvarial-based mass.
OPERATIONS PERFORMED:
1. Left frontal craniectomy, resection of calvarial based mass.
2. Cranioplasty, 4.5 x 6.5 cm, with titanium mesh, repair calvarial defect.
3. Stealth neuronavigation, frameless stereotactic, preoperative planning and volumetric resection.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General.
DESCRIPTION OF OPERATION: After informed consent was obtained, the patient was taken to the operating room where she was placed in the supine position upon the operating table, and all pressure points were padded. Adequate general anesthesia was induced and maintained with a combination of intravenous and inhalational agents.
The patient’s head was secured in a Mayfield 3-pin head holder. The head and neck were secured to the operating table using the Mayfield articulated arm. All connections were secured. Stealth neuronavigation frameless stereotactic was registered using surface fiducial markers, and accuracy at the operative site found to be acceptable, with less than 1 mm error. The scalp was clipped and shaved and a Sutar-type bicoronal incision scribed down to the skin with gentian violet behind the hairline per the patient’s request. The scalp was prepared with DuraPrep solution and draped in the usual sterile manner with an iodine-impregnated adhesive sheet placed over all areas of exposed skin. Intravenous cephazolin was administered for perioperative prophylactic antibiotic coverage.
The scalp incision was infiltrated with 1% lidocaine with 1:100,000 units epinephrine. The skin incision was created and carried to calvarium sharply. The temporalis fascia was not violated on either side, and subperiosteal dissection was utilized to elevate the soft tissue flap. The inferior left frontal/supraorbital region on the left was fully exposed. The patient’s globes were protected with protective goggles. The soft tissue flap was protected with a saline moist and 4 x 4 gauze sponge and reflected over 4 x 4 fluffs and gently retracted with fish hooks. The stealth neuronavigation station was utilized to identify the margins of the calvarial mass, and this was marked down to the skull with sterile marking pen.
A small trephine was created with B1 Midas Rex drill bit to the dura. The dura was separated from the inner table of the calvarium. The calvarial mass was resected with approximately 0.5 to 1 cm margins of healthy bone circumferentially. The calvarial-based mass was found to extend over the orbital roof. Using Midas Rex high-speed air drill and an AMA dissecting tool, the calvarial mass was resected. The mass itself was found to be within the diploe. The calvarium was debrided back to healthy-appearing bone and a gross total tumor resection was achieved. The confines of the orbit were not entered at any time. The frontal sinus likewise was not entered. Once the mass had been resected, attention was turned to reparative cranioplasty. A 4.5 x 6.5 cm sheet of titanium mesh was custom molded to conform to the patient’s calvarium. It was secured to the bony margins using Synthes cranial screws sunk flush to the mesh.
The wound was irrigated with copious normal saline irrigant bacitracin solution. Meticulous hemostasis achieved. The galea aponeurotica was closed with 2-0 Vicryl simple interrupted inverted suture and the skin with 3-0 monofilament nylon running suture. The sterile dressings were applied over the wound. The operative drapes were taken down and the Mayfield 3-pin head holder removed. A partial-thickness laceration was noted posterior to the left parietal pin. This was cleansed with Betadine and sutured primarily with 3-0 monofilament nylon. The sterile dressing was applied here as well. General anesthesia was reversed and endotracheal tube withdrawn. The patient was subsequently transferred to postanesthesia care unit for postoperative monitoring. Estimated blood loss was 100 mL, none replaced. Sponge and needle count was correct x2. The patient tolerated the surgical procedure well and was returned to the recovery room in stable condition, neurologically intact.
