DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Multiple aneurysms.
2. Left carotid ophthalmic aneurysm.
3. Right carotid occlusion.
POSTOPERATIVE DIAGNOSES:
1. Multiple aneurysms.
2. Left carotid ophthalmic aneurysm.
3. Right carotid occlusion.
PROCEDURE PERFORMED:
Left STA-MCA bypass.
SURGEON: John Doe, MD
COMPLICATIONS: None.
SPECIMENS: None.
DESCRIPTION OF OPERATION: The patient was intubated and placed in the supine position with the head tilted to the right for the left STA-MCA bypass. The superficial temporal artery was mapped and the posterior branch was selected. The area was prepped and draped in sterile fashion.
An incision was made with a 10 blade, and then with the use of scissors and bipolar coagulation, the posterior branch of the superficial temporal artery was isolated and prepared. Then, the muscle was opened in a cruciate fashion and retracted. The bone was entered with the Midas Rex and a small craniotomy was performed. The dura was opened, and under the microscope with microdissection, a branch of the middle cerebral artery was dissected free and prepared for bypass. At this point, attention was diverted to the superficial temporary artery branch which was also prepared and was cross-clamped and irrigated with heparinized solution. At this point, the superficial temporal artery branch was brought down to the cortical branch, which was again cross-clamped with two 3 mm clips and then opened and the anastomosis performed with interrupted 10-0 Prolene. At the end of the anastomosis, the distal clips and proximal clips were removed from the cortical branch of the MCA and then the clip was removed from the superficial temporal artery. The system appeared to be working perfectly and was confirmed also by Doppler sound.
At this point, the area was irrigated with warm lactated Ringer’s. The anastomosis was covered with Surgicel. The dura was partially closed with 4-0 Vicryl. The bone flap was also partially replaced and fixed with mini plates. Muscle was closed with 2-0 Vicryls, subcutaneous tissue with 3-0 Vicryl and the skin closed with 3-0 nylon. At the end of surgery, the Doppler was used to verify the function of the bypass, which appeared to be perfect.
