DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left frontal meningioma.
POSTOPERATIVE DIAGNOSIS: Left frontal meningioma.
PROCEDURE PERFORMED: Left frontotemporal craniotomy with removal of frontal meningioma.
SURGEON: John Doe, MD
DESCRIPTION OF PROCEDURE: The patient underwent partial clipping of her hair. Fiducial markers were placed and then an MRI was obtained. The patient was then transported to the preanesthesia area. Once all lines were secured, the patient was brought to the operating room for left frontotemporal craniotomy.
General anesthesia was induced. The patient’s head was then placed in skeletal fixation using the Mayfield skull clamp. Registration was performed with the navigation system. After registration, it appeared as though the navigation system correlated quite well with known anatomy.
A safety pause was performed, which appeared successful. The patient had been positioned with her head rotated toward the right and slightly extended. We marked out an incision for a pterional craniotomy. The skin was infiltrated with local anesthetic. The scalp flap was reflected anteriorly.
Next, the temporalis muscle was reflected anteriorly; however, a flap of temporalis muscle was left on the skull. Following this, with a high speed electric drill, a free bone flap was done. The bone flap included a small portion of the temporal area and a larger portion of the frontal area.
In the area of the tumor, there was some extra drilling of the bone to make sure that we had very good exposure. The dura was then opened in a curvilinear fashion. At the distal end of the sylvian fissure, the arachnoid was opened. This provided for very good brain relaxation.
We then reflected the dura anteriorly, and as we did this, we encountered the meningioma. This was easily dissected off the cortical surface. Bleeding was controlled with bipolar coagulation. A frozen section was performed, and we were told that the frozen section was consistent with a meningioma.
Following this, the tumor was debulked. Then, we identified the edges of the dural involvement. We then resected all involved dura.
It should be noted that there was an anterior sylvian vein, which drained into the area of the pterion. This was not disturbed. We then used bovine pericardium as a dural substitute. It was sewn in along the edges at the convexity; however, at the skull base, it was just tacked in several locations.
We also then used some titanium mesh at the anterior aspect of the craniotomy bone flap to support the hydroxyapatite. Prior to putting the hydroxyapatite in, the bone was reaffixed to the skull with a titanium plating system.
Next, the edges of the craniotomy defect were grouted with hydroxyapatite. This was allowed to harden. Once it had hardened, the temporalis muscle was reaffixed to its cuff that was left on the skull.
The galea was then closed with 2-0 Vicryl suture material. Stainless steel staples were placed. The patient tolerated the frontotemporal craniotomy well.
The patient was allowed to awaken from the general anesthetic, extubated and brought to the surgical intensive care unit in stable condition.
